Provider Demographics
NPI:1275823262
Name:MENDEZ, SHARON LEE (OTR)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LEE
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N1502 SOUTHERN RD
Mailing Address - Street 2:
Mailing Address - City:LYNDON STATION
Mailing Address - State:WI
Mailing Address - Zip Code:53944-9771
Mailing Address - Country:US
Mailing Address - Phone:608-547-8972
Mailing Address - Fax:
Practice Address - Street 1:201 S PARK AVE
Practice Address - Street 2:
Practice Address - City:FRIENDSHIP
Practice Address - State:WI
Practice Address - Zip Code:53934-9377
Practice Address - Country:US
Practice Address - Phone:608-339-3361
Practice Address - Fax:608-339-9468
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3164-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist