Provider Demographics
NPI:1003185661
Name:SMITH, SHARON MARCIA (OTR)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:MARCIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 MOUNCE FARM WAY
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-8240
Mailing Address - Country:US
Mailing Address - Phone:339-933-1778
Mailing Address - Fax:
Practice Address - Street 1:56 MOUNCE FARM WAY
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-8240
Practice Address - Country:US
Practice Address - Phone:339-933-1778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0053871251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)