Provider Demographics
NPI:1417155110
Name:LAWRENCE, SHARON D (PTA)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:D
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-3117
Mailing Address - Country:US
Mailing Address - Phone:580-331-1471
Mailing Address - Fax:580-323-8305
Practice Address - Street 1:100 N 30TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-3117
Practice Address - Country:US
Practice Address - Phone:580-331-1471
Practice Address - Fax:580-323-8305
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKTA888225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant