Provider Demographics
NPI:1619031382
Name:SHYNE, MAURISA D (OT)
Entity Type:Individual
Prefix:MS
First Name:MAURISA
Middle Name:D
Last Name:SHYNE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6231 LEESBURG PIKE
Mailing Address - Street 2:SUITE L-1
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2102
Mailing Address - Country:US
Mailing Address - Phone:703-536-1817
Mailing Address - Fax:704-536-5677
Practice Address - Street 1:6231 LEESBURG PIKE
Practice Address - Street 2:SUITE L-1
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2102
Practice Address - Country:US
Practice Address - Phone:703-536-1817
Practice Address - Fax:704-536-5677
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003195174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist