Provider Demographics
NPI:1821204975
Name:LAZENBY, SHARON M (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:M
Last Name:LAZENBY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:M
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:10506 RIVERSIDE RD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33981-5128
Mailing Address - Country:US
Mailing Address - Phone:941-704-8451
Mailing Address - Fax:941-807-0876
Practice Address - Street 1:10506 RIVERSIDE RD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33981-5128
Practice Address - Country:US
Practice Address - Phone:941-704-8451
Practice Address - Fax:941-870-0876
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA359224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant