Provider Demographics
NPI:1083644686
Name:TABOR, SHARON L (CPED/CFO)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:L
Last Name:TABOR
Suffix:
Gender:F
Credentials:CPED/CFO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 W FAIR AVE
Mailing Address - Street 2:SUITE 50
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2675
Mailing Address - Country:US
Mailing Address - Phone:906-225-7978
Mailing Address - Fax:906-225-7707
Practice Address - Street 1:1414 W FAIR AVE
Practice Address - Street 2:SUITE 50
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2675
Practice Address - Country:US
Practice Address - Phone:906-225-7978
Practice Address - Fax:906-225-7707
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINONE REQUIRED225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5775900001Medicare NSC