Provider Demographics
NPI:1881325298
Name:OAKLEY, VICTORIA SHAW
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:SHAW
Last Name:OAKLEY
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 1:2147 FEATHERWOOD DR W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32233-6922
Mailing Address - Country:US
Mailing Address - Phone:904-887-0971
Mailing Address - Fax:
Practice Address - Street 1:15255 MAX LEGGETT PKWY STE 5300
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-7274
Practice Address - Country:US
Practice Address - Phone:904-203-1386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23260225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist