Provider Demographics
NPI:1710142104
Name:MENDOZA, SHARON SOMBRIO (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:SOMBRIO
Last Name:MENDOZA
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 1:380 MORNING DEW CIR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-7101
Mailing Address - Country:US
Mailing Address - Phone:678-469-0633
Mailing Address - Fax:770-904-2357
Practice Address - Street 1:380 MORNING DEW CIR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-7101
Practice Address - Country:US
Practice Address - Phone:678-469-0633
Practice Address - Fax:855-560-1618
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003979225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist