Provider Demographics
NPI:1043264518
Name:KUZNETSOV, SHARON LYNN (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LYNN
Last Name:KUZNETSOV
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:HOESEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L, CHT
Mailing Address - Street 1:563 MADISON AVE N
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1768
Mailing Address - Country:US
Mailing Address - Phone:206-855-8455
Mailing Address - Fax:206-855-8465
Practice Address - Street 1:563 MADISON AVE N
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1768
Practice Address - Country:US
Practice Address - Phone:206-855-8455
Practice Address - Fax:206-855-8465
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003759225XH1200X
WAOT00003756225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00264836OtherRAILROAD MEDICARE
WA8379364Medicaid
WAG8948780OtherMEDICARE
WA8806597Medicare ID - Type Unspecified