Provider Demographics
NPI:1861974826
Name:PRIMM, SHAHIED (OT/L)
Entity type:Individual
Prefix:MR
First Name:SHAHIED
Middle Name:
Last Name:PRIMM
Suffix:
Gender:M
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 N CASTLEFORD CT
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-4582
Mailing Address - Country:US
Mailing Address - Phone:321-439-6444
Mailing Address - Fax:
Practice Address - Street 1:255 N CASTLEFORD CT
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-4582
Practice Address - Country:US
Practice Address - Phone:321-439-6444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT4258225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology