Healthcare Provider Details

I. General information

NPI: 1083644686
Provider Name (Legal Business Name): SHARON L TABOR CPED/CFO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W FAIR AVE SUITE 50
MARQUETTE MI
49855-2675
US

IV. Provider business mailing address

1414 W FAIR AVE SUITE 50
MARQUETTE MI
49855-2675
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-7978
  • Fax: 906-225-7707
Mailing address:
  • Phone: 906-225-7978
  • Fax: 906-225-7707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberNONE REQUIRED
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: