Healthcare Provider Details

I. General information

NPI: 1861621310
Provider Name (Legal Business Name): SHARON MARIE LANKES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 07/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13150 DORMAN RD
PINEVILLE NC
28134-9382
US

IV. Provider business mailing address

13150 DORMAN RD
PINEVILLE NC
28134-9382
US

V. Phone/Fax

Practice location:
  • Phone: 704-544-2552
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number7199
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: