Provider Demographics
NPI:1053304873
Name:MASON, SHARON LYNN (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LYNN
Last Name:MASON
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:LYNN
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTD, OTR/L
Mailing Address - Street 1:12356 TEX TAN RD
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-7977
Mailing Address - Country:US
Mailing Address - Phone:719-648-3764
Mailing Address - Fax:
Practice Address - Street 1:421 S TEJON ST
Practice Address - Street 2:SUITE 311
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-2131
Practice Address - Country:US
Practice Address - Phone:719-648-3764
Practice Address - Fax:719-886-7113
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2013-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1986225X00000X
CO1686225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM87804221Medicaid
NMNM00Q167OtherBLUE CROSS BLUE SHIELD