| NPI | 1811243074 |
|---|---|
| Former Name | CANDY TYAN SHAW |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: 993772) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-11-9504) |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2014-03-07 |