Provider Demographics
NPI:1841449204
Name:GEORGE, SHINEY MARY
Entity type:Individual
Prefix:
First Name:SHINEY
Middle Name:MARY
Last Name:GEORGE
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 1:5428 MAIN ST
Mailing Address - Street 2:SKOKIE
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2030
Mailing Address - Country:US
Mailing Address - Phone:847-858-7964
Mailing Address - Fax:
Practice Address - Street 1:5428 MAIN ST
Practice Address - Street 2:SKOKIE
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2030
Practice Address - Country:US
Practice Address - Phone:847-858-7964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056008459225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist