Provider Demographics
NPI:1720214851
Name:OSHOA-MCEWEN, MARCIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:OSHOA-MCEWEN
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 1:2398 SW INDIGO LN
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2158
Mailing Address - Country:US
Mailing Address - Phone:772-336-7587
Mailing Address - Fax:772-343-7676
Practice Address - Street 1:2398 SW INDIGO LN
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2158
Practice Address - Country:US
Practice Address - Phone:772-336-7587
Practice Address - Fax:772-343-7676
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11198225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT11198OtherFLORIDA BOARD OF OCCUPATIONAL THERAPY