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NPI Code Detail

MEDICARE: MRS. SHARLENE V CHILDS OTRL

MEDICARE: MRS. SHARLENE V CHILDS OTRL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist2651NC

General Provider Information

NPI Number : 1114909025
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHARLENE V CHILDS OTRL
Provider Business Mailing Address
First Line : PO BOX 667744
Second Line :
City : CHARLOTTE
State : NC
Zip : 28266-7744
Country : US
Telephone Number : 704-588-4757
Fax Number : 704-583-5367
Provider Business Practice Location Address
First Line : 4221 TUCKASEEGEE RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28208-2801
Country : US
Telephone Number : 704-392-4057
Fax Number : 704-392-4788
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2005
Last Update Date : 07/08/2007

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