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 |