Provider Demographics
NPI:1003294885
Name:WITTMEYER CROWLEY, SHARON LEE (COTA)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LEE
Last Name:WITTMEYER CROWLEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:LEE
Other - Last Name:WITTMEYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA
Mailing Address - Street 1:4757 ROUTE 305
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:NY
Mailing Address - Zip Code:14727-1491
Mailing Address - Country:US
Mailing Address - Phone:716-560-4005
Mailing Address - Fax:585-968-0230
Practice Address - Street 1:4757 ROUTE 305
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:NY
Practice Address - Zip Code:14727-1491
Practice Address - Country:US
Practice Address - Phone:716-560-4005
Practice Address - Fax:585-968-0230
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006638-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant