Provider Demographics
NPI:1154530426
Name:SHIELDS, MARTINA CHRISTINE (OTRL)
Entity type:Individual
Prefix:MRS
First Name:MARTINA
Middle Name:CHRISTINE
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 COLONIAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-2621
Mailing Address - Country:US
Mailing Address - Phone:267-312-9446
Mailing Address - Fax:
Practice Address - Street 1:242 COLONIAL PARK DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2621
Practice Address - Country:US
Practice Address - Phone:267-312-9446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008820225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist