Provider Demographics
NPI:1083812036
Name:SOMMERVILLE, SHARON M (OTR)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:M
Last Name:SOMMERVILLE
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 1:5061 DOE CIR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-3732
Mailing Address - Country:US
Mailing Address - Phone:317-372-2628
Mailing Address - Fax:317-299-8005
Practice Address - Street 1:5061 DOE CIR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-3732
Practice Address - Country:US
Practice Address - Phone:317-372-2628
Practice Address - Fax:317-299-8005
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31001417A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist