Provider Demographics
NPI:1093217564
Name:MALINOWSKI, SHARON DIANE (OTRL)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:DIANE
Last Name:MALINOWSKI
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4949 COOLIDGE HWY SECTION E, ADULT NEURO OT
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067
Mailing Address - Country:US
Mailing Address - Phone:248-655-5800
Mailing Address - Fax:248-655-5801
Practice Address - Street 1:4949 COOLIDGE HWY SECTION E, ADULT NEURO OT
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067
Practice Address - Country:US
Practice Address - Phone:248-655-5800
Practice Address - Fax:248-655-5801
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201004636225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist