Healthcare Provider Details

I. General information

NPI: 1376239376
Provider Name (Legal Business Name): SHARON BROOKE MILDRED BLACKSTONE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1536 FORDING ISLAND RD
HILTON HEAD ISLAND SC
29926-1120
US

IV. Provider business mailing address

36512 TAYLOR DR
JERUSALEM OH
43747-9650
US

V. Phone/Fax

Practice location:
  • Phone: 843-837-2080
  • Fax:
Mailing address:
  • Phone: 740-827-3344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6822
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: