Provider Demographics
NPI:1215549209
Name:TICKLE, SHARON (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:TICKLE
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 CP PARKER LANE
Mailing Address - Street 2:
Mailing Address - City:NIMITZ
Mailing Address - State:WV
Mailing Address - Zip Code:25978
Mailing Address - Country:US
Mailing Address - Phone:681-207-6284
Mailing Address - Fax:
Practice Address - Street 1:1987 OLD PRINCETON RD
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-8049
Practice Address - Country:US
Practice Address - Phone:681-207-6284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2012-3002225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist