MEDICARE: SHARON MILLER BARKSDALE COTA/L

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
1	224Z00000X	Occupational Therapy Assistant	01310000459	VA
2	224Z00000X	Occupational Therapy Assistant	0310000459	VA

General Provider Information

NPI Number	:	1982112413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON MILLER BARKSDALE COTA/L

Provider Business Mailing Address
First Line	:	5009 CEDAR FORK TER
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-3399
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9010 WOODMAN RD
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23228-2148
Country	:	US
Telephone Number	:	804-330-6123
Fax Number	:	804-330-6127

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2018
Last Update Date	:	01/18/2018

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