Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 46TR01031500 | NJ |
NPI | 1972262608 |
---|---|
Provider Name | Allizey Shields |
First Address | Eatontown, NJ 07724-2535 |
Second Address | Forked River, NJ 08731-4654 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2021 |
Last Update Date | 09/12/2021 |