=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104430560
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHARON ROSE CICCONE LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2020
-----------------------------------------------------
Last Update Date | 08/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 408 S MAPLE ST
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52556-3740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-451-0465
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 602 N MAIN ST
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52556-2236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-482-3027
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171400000X
-----------------------------------------------------
Taxonomy Name | Health & Wellness Coach
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MSG011973
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 128118
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------