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General NPI Number Information
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NPI Number | 1013426915
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Entity Type | Individual
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Provider Name | KYLA KIMBERLY SHARRAH MOT
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Gender | Female
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Dates
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Enumeration Date | 09/22/2017
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Last Update Date | 09/22/2017
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Provider Practice Location Address
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Address Line | 9141 CYPRESS GREEN DR STE 2
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City | JACKSONVILLE
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State | FL
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Zip | 32256-2006
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Country | US
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Telephone | 904-647-1849
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Fax |
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Provider Business Mailing Address
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Address Line | 113 KINGS MANOR CT
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5283
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Country | US
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Telephone | 717-357-6595
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State | FL
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