Provider Demographics
NPI:1114909025
Name:CHILDS, SHARLENE V (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:SHARLENE
Middle Name:V
Last Name:CHILDS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 667744
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28266-7744
Mailing Address - Country:US
Mailing Address - Phone:704-588-4757
Mailing Address - Fax:704-583-5367
Practice Address - Street 1:4221 TUCKASEEGEE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-2801
Practice Address - Country:US
Practice Address - Phone:704-392-4057
Practice Address - Fax:704-392-4788
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2651225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist