Provider Demographics
NPI:1942722608
Name:ROTHMAN, SHANA COLE
Entity Type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:COLE
Last Name:ROTHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHANA
Other - Middle Name:COLE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5012 MONET AVE
Mailing Address - Street 2:
Mailing Address - City:BELLE ISLE
Mailing Address - State:FL
Mailing Address - Zip Code:32812-1047
Mailing Address - Country:US
Mailing Address - Phone:561-909-7969
Mailing Address - Fax:
Practice Address - Street 1:7203 ALOMA AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-7101
Practice Address - Country:US
Practice Address - Phone:321-972-3960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT18493225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist