MEDICARE: AIMEE GRACE SHOOK

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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1841578192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIMEE GRACE SHOOK

Provider Business Mailing Address
First Line	:	8532 CANTERBURY LAKE BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-6674
Country	:	US
Telephone Number	:	813-382-2056
Fax Number	:

Provider Business Practice Location Address
First Line	:	8532 CANTERBURY LAKE BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-6674
Country	:	US
Telephone Number	:	813-382-2056
Fax Number	:

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

Provider Enumeration Date	:	08/03/2011
Last Update Date	:	08/03/2011

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Directions to “ AIMEE GRACE SHOOK ” Practice Location

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