Provider Demographics
NPI:1104988468
Name:SHAW, PEGGY J (OT)
Entity type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:J
Last Name:SHAW
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8130 66TH ST
Mailing Address - Street 2:SUITE #12
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-2111
Mailing Address - Country:US
Mailing Address - Phone:727-541-2091
Mailing Address - Fax:727-545-0503
Practice Address - Street 1:8130 66TH ST
Practice Address - Street 2:SUITE #12
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-2111
Practice Address - Country:US
Practice Address - Phone:727-541-2091
Practice Address - Fax:727-545-0503
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOT 268225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics