Provider Demographics
NPI:1417156720
Name:MARTIN, SHARON D (ITDS)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:D
Last Name:MARTIN
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-5850
Mailing Address - Country:US
Mailing Address - Phone:813-416-5159
Mailing Address - Fax:
Practice Address - Street 1:1305 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-5850
Practice Address - Country:US
Practice Address - Phone:813-416-5159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist