Provider Demographics
NPI:1477674646
Name:DODD-BLAKE, SHARON ROSALEE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ROSALEE
Last Name:DODD-BLAKE
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 1:164 PLUMOSUS DR
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5213
Mailing Address - Country:US
Mailing Address - Phone:407-767-0940
Mailing Address - Fax:407-767-2077
Practice Address - Street 1:164 PLUMOSUS DR
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5213
Practice Address - Country:US
Practice Address - Phone:407-767-0940
Practice Address - Fax:407-767-2077
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT8625225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU5608ZMedicare ID - Type UnspecifiedINDIVIDUAL NUMBER