Provider Demographics
NPI:1124564653
Name:MCDONALD, SHARON (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11841 ABBEY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-2633
Mailing Address - Country:US
Mailing Address - Phone:440-237-3112
Mailing Address - Fax:
Practice Address - Street 1:11841 ABBEY RD
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-2633
Practice Address - Country:US
Practice Address - Phone:440-237-3112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-08
Last Update Date:2017-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA 04109405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional