Provider Demographics
NPI:1497237945
Name:WASHINGTON, SHARON (COTA, LOTA)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:COTA, LOTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 KACHINA LN
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-3334
Mailing Address - Country:US
Mailing Address - Phone:405-696-2549
Mailing Address - Fax:
Practice Address - Street 1:310 S JUPITER RD
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-3039
Practice Address - Country:US
Practice Address - Phone:972-727-5850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
212666224ZE0001X
TX212666224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No224ZE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantEnvironmental Modification