Provider Demographics
NPI:1902942642
Name:AGUIAR, SHANNON LEE (OTR)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:LEE
Last Name:AGUIAR
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 W GRANADA BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8165
Mailing Address - Country:US
Mailing Address - Phone:386-898-0220
Mailing Address - Fax:
Practice Address - Street 1:1180 W GRANADA BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8165
Practice Address - Country:US
Practice Address - Phone:386-898-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT5803225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist