Healthcare Provider Details

I. General information

NPI: 1598172207
Provider Name (Legal Business Name): SHARDA LATECE ALLEN MS,OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 OLD HOWELL RD
GREENVILLE SC
29615-1969
US

IV. Provider business mailing address

1945 S BROWNSTONE CT SW
DECATUR AL
35603-2025
US

V. Phone/Fax

Practice location:
  • Phone: 877-508-3237
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT0000004841
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3425
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: