Provider Demographics
NPI:1205028289
Name:SHARPE, JOHN A (MS OTR/L)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:A
Last Name:SHARPE
Suffix:
Gender:M
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-4314
Mailing Address - Country:US
Mailing Address - Phone:631-581-5607
Mailing Address - Fax:
Practice Address - Street 1:187 UNION AVE
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-4314
Practice Address - Country:US
Practice Address - Phone:631-581-5607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009116-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist