Healthcare Provider Details

I. General information

NPI: 1548489115
Provider Name (Legal Business Name): SHARLENE MARIE ERVIN OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARLENE MARIE LANGBEIN OT

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4466 W BRISTOL RD
FLINT MI
48507-3170
US

IV. Provider business mailing address

4466 W BRISTOL RD
FLINT MI
48507-3170
US

V. Phone/Fax

Practice location:
  • Phone: 810-285-8523
  • Fax: 810-820-9582
Mailing address:
  • Phone: 810-285-8523
  • Fax: 810-820-9582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201001258
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: