MEDICARE: SHAVONNE ORR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	225X00000X	Occupational Therapist	OT23874	FL

General Provider Information

NPI Number	:	1134787245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAVONNE ORR

Provider Business Mailing Address
First Line	:	997 ATLANTIC BLVD
Second Line	:
City	:	ATLANTIC BEACH
State	:	FL
Zip	:	32233-3311
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	997 ATLANTIC BLVD
Second Line	:
City	:	ATLANTIC BEACH
State	:	FL
Zip	:	32233-3311
Country	:	US
Telephone Number	:	904-647-1849
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2019
Last Update Date	:	05/04/2023

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Directions to “ SHAVONNE ORR ” Practice Location

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