Provider Demographics
NPI:1376774414
Name:EICHENBERGER, SHARLENE J
Entity Type:Individual
Prefix:
First Name:SHARLENE
Middle Name:J
Last Name:EICHENBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6054
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-0654
Mailing Address - Country:US
Mailing Address - Phone:727-368-4940
Mailing Address - Fax:
Practice Address - Street 1:812 BERKLEY CT S
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3000
Practice Address - Country:US
Practice Address - Phone:727-368-4940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist