Provider Demographics
NPI:1407360688
Name:SANTIAGO, SHARMAINE MORAN (PT)
Entity Type:Individual
Prefix:MISS
First Name:SHARMAINE
Middle Name:MORAN
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 N 6TH ST APT 201
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-6034
Mailing Address - Country:US
Mailing Address - Phone:206-487-6754
Mailing Address - Fax:
Practice Address - Street 1:1401 BRYANT WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-7151
Practice Address - Country:US
Practice Address - Phone:206-487-6754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1284165225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist