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General NPI Number Information
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NPI Number | 1811794852
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Entity Type | Individual
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Provider Name | KATIE AMANDA SHIRK
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Gender | Female
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Dates
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Enumeration Date | 02/27/2025
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 2080 W EAU GALLIE BLVD STE A
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City | MELBOURNE
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State | FL
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Zip | 32935-3185
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Country | US
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Telephone | 407-694-3603
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Fax |
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Provider Business Mailing Address
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Address Line | 741 COBBLESTONE LN NE
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City | PALM BAY
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State | FL
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Zip | 32905-5427
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Country | US
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Telephone | 304-834-9535
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT25955
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License Number State | FL
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