Provider Demographics
NPI:1538508999
Name:MALLORY, SHARON K (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:K
Last Name:MALLORY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 HIGH BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WILMORE
Mailing Address - State:KY
Mailing Address - Zip Code:40390-9707
Mailing Address - Country:US
Mailing Address - Phone:859-858-3282
Mailing Address - Fax:
Practice Address - Street 1:2290 HIGH BRIDGE RD
Practice Address - Street 2:
Practice Address - City:WILMORE
Practice Address - State:KY
Practice Address - Zip Code:40390-9707
Practice Address - Country:US
Practice Address - Phone:859-858-3282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR0159225X00000X
KY134060225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist