Provider Demographics
NPI:1760619886
Name:O'BRIEN, SHARON SUZANNE
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:SUZANNE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S CLOVIS AVE APT 139
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-4215
Mailing Address - Country:US
Mailing Address - Phone:559-412-4531
Mailing Address - Fax:
Practice Address - Street 1:230 S CLOVIS AVE APT 139
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-4215
Practice Address - Country:US
Practice Address - Phone:559-412-4531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA649224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant