Provider Demographics
NPI:1417229824
Name:GEORGE-JEFFERSON, SHUNDREYA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SHUNDREYA
Middle Name:
Last Name:GEORGE-JEFFERSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 OAK ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36108-2829
Mailing Address - Country:US
Mailing Address - Phone:334-264-8887
Mailing Address - Fax:334-264-1605
Practice Address - Street 1:1031 OAK ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36108-2829
Practice Address - Country:US
Practice Address - Phone:334-264-8887
Practice Address - Fax:334-264-1605
Is Sole Proprietor?:No
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2125225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist