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General NPI Number Information
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NPI Number | 1578829115
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Entity Type | Organization
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Legal Business Name | SHAMROCK THERAPY SERVICES
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Dates
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Enumeration Date | 04/09/2012
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Last Update Date | 04/09/2012
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Provider Practice Location Address
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Address Line | 2910 SE 7TH ST
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City | OCALA
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State | FL
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Zip | 34471-2768
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Country | US
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Telephone | 352-804-0753
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Fax | 352-620-2272
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Provider Business Mailing Address
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Address Line | 2910 SE 7TH ST
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City | OCALA
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State | FL
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Zip | 34471-2768
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Country | US
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Telephone | 352-804-0753
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Fax | 352-620-2272
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Authorized Official
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Title or Position | OCCPATIONAL THERAPIST/OWNER
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Name | MRS. KATHLEEN BANTA
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Credential | OTR
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Telephone | 352-804-0753
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 354
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License Number State | FL
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