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General NPI Number Information
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NPI Number | 1225277031
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Entity Type | Individual
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Provider Name | BRIAN DAVID SHAMS OTR/L
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Gender | Male
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Dates
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Enumeration Date | 02/18/2009
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 1301 BALLENTYNE PL
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City | APOPKA
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State | FL
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Zip | 32703-6870
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Country | US
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Telephone | 407-595-5438
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 BALLENTYNE PL
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City | APOPKA
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State | FL
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Zip | 32703-6870
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Country | US
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Telephone | 407-595-5438
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | OT-4778
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License Number State | FL
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