Provider Demographics
NPI:1609983410
Name:COSPER, SHARON NEWTON (OTR-L)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:NEWTON
Last Name:COSPER
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 1:2351 RUBY DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-3047
Mailing Address - Country:US
Mailing Address - Phone:706-495-2619
Mailing Address - Fax:
Practice Address - Street 1:2315 CENTRAL AVE STE C
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6246
Practice Address - Country:US
Practice Address - Phone:706-364-6172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004386225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA113248775AMedicaid