Provider Demographics
NPI:1871645283
Name:CARROLL, SHARON R (COTA)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:R
Last Name:CARROLL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:SHARON
Other - Middle Name:R
Other - Last Name:FRAASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:5217 MAPLETON RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-9293
Mailing Address - Country:US
Mailing Address - Phone:716-625-6096
Mailing Address - Fax:
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-898-3574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000352-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant