Provider Demographics
NPI:1659793578
Name:HARTLEY, SHARON (LMT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 448
Mailing Address - Street 2:
Mailing Address - City:LYLE
Mailing Address - State:WA
Mailing Address - Zip Code:98635-0010
Mailing Address - Country:US
Mailing Address - Phone:541-490-6929
Mailing Address - Fax:541-387-4326
Practice Address - Street 1:104 5TH ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-2058
Practice Address - Country:US
Practice Address - Phone:541-298-2378
Practice Address - Fax:541-370-2843
Is Sole Proprietor?:No
Enumeration Date:2014-01-12
Last Update Date:2014-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6814225700000X
WAMA00011133225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist