SHANE MICHAEL DISHEAUX

FORT WAYNE, IN
NPI1508063645
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy224Z00000X Occupational Therapy Assistant
(Licence: IN  32001345A)
Enumeration Date2007-07-02
Last Update Date2007-07-08
Business Address
Mr. SHANE MICHAEL DISHEAUX COTA
2827 NORTHGATE BLVD
FORT WAYNE, IN 46835-2903
Phone number: 260-492-1498
Mailing Address
Mr. SHANE MICHAEL DISHEAUX COTA
5305 WOODWAY DR
FORT WAYNE, IN 46835-3676
Phone number: 260-492-2027
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