Provider Demographics
NPI:1922338318
Name:SHRADER, ANN MARIE
Entity Type:Individual
Prefix:MS
First Name:ANN MARIE
Middle Name:
Last Name:SHRADER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 MOSSY CYPRESS LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-5023
Mailing Address - Country:US
Mailing Address - Phone:904-292-3845
Mailing Address - Fax:
Practice Address - Street 1:1736 MOSSY CYPRESS LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-5023
Practice Address - Country:US
Practice Address - Phone:904-292-3845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist