Provider Demographics
NPI:1588010375
Name:MCLANE, SHORENA (COTA)
Entity Type:Individual
Prefix:
First Name:SHORENA
Middle Name:
Last Name:MCLANE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:SHORENA
Other - Middle Name:
Other - Last Name:TOTLADZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1880 E 4TH ST
Mailing Address - Street 2:APT B11
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-2834
Mailing Address - Country:US
Mailing Address - Phone:347-274-4149
Mailing Address - Fax:
Practice Address - Street 1:1880 E 4TH ST
Practice Address - Street 2:APT B11
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2834
Practice Address - Country:US
Practice Address - Phone:347-274-4149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008817224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant