Provider Demographics
NPI:1821448614
Name:SLOAN, SHACINDRA (OTA)
Entity Type:Individual
Prefix:MS
First Name:SHACINDRA
Middle Name:
Last Name:SLOAN
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4651 ELM RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-5624
Mailing Address - Country:US
Mailing Address - Phone:678-334-3607
Mailing Address - Fax:
Practice Address - Street 1:4651 ELM RIDGE CT
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-5624
Practice Address - Country:US
Practice Address - Phone:678-334-3607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA001621224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant