Provider Demographics
NPI:1497317671
Name:BERTRAND, SHARON LYNN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:LYNN
Last Name:BERTRAND
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:SHARON
Other - Middle Name:L
Other - Last Name:BERTRAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:209 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-2019
Mailing Address - Country:US
Mailing Address - Phone:707-235-1107
Mailing Address - Fax:707-754-2565
Practice Address - Street 1:209 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2019
Practice Address - Country:US
Practice Address - Phone:707-235-1107
Practice Address - Fax:707-754-2565
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6499225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT0064990OtherBLUE SHIELD