Healthcare Provider Details

I. General information

NPI: 1043264518
Provider Name (Legal Business Name): SHARON LYNN KUZNETSOV OTR/L, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARON HOESEL OTR/L, CHT

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

563 MADISON AVE N
BAINBRIDGE ISLAND WA
98110-1768
US

IV. Provider business mailing address

563 MADISON AVE N
BAINBRIDGE ISLAND WA
98110-1768
US

V. Phone/Fax

Practice location:
  • Phone: 206-855-8455
  • Fax: 206-855-8465
Mailing address:
  • Phone: 206-855-8455
  • Fax: 206-855-8465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT00003756
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT00003759
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: