Provider Demographics
NPI:1114609369
Name:FAIRCLOTH, SHARON ELIZABETH (OT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:ELIZABETH
Last Name:FAIRCLOTH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 TREMAYNE PL APT 311
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-7701
Mailing Address - Country:US
Mailing Address - Phone:703-963-9927
Mailing Address - Fax:
Practice Address - Street 1:8315 TURNING LEAF LN
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-2615
Practice Address - Country:US
Practice Address - Phone:703-734-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist