Provider Demographics
NPI:1568673382
Name:NEAL, SHARON LYNN (LRT, CTRS)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LYNN
Last Name:NEAL
Suffix:
Gender:F
Credentials:LRT, CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 WESTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BUTNER
Mailing Address - State:NC
Mailing Address - Zip Code:27509-1633
Mailing Address - Country:US
Mailing Address - Phone:919-575-5704
Mailing Address - Fax:
Practice Address - Street 1:104 WESTBROOK DR
Practice Address - Street 2:
Practice Address - City:BUTNER
Practice Address - State:NC
Practice Address - Zip Code:27509-1633
Practice Address - Country:US
Practice Address - Phone:919-575-5704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC229225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCRTBL229OtherSTATE OF NORTH CAROLINA L