Provider Demographics
NPI:1922403260
Name:AHLSWEDE, SHARON (MOTR)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:AHLSWEDE
Suffix:
Gender:F
Credentials:MOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1939 MINNEHAHA AVE W STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1033
Mailing Address - Country:US
Mailing Address - Phone:651-748-4338
Mailing Address - Fax:651-748-2892
Practice Address - Street 1:146 LAKE ST N STE 200
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2555
Practice Address - Country:US
Practice Address - Phone:651-275-4706
Practice Address - Fax:651-770-1180
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5547225X00000X
UT11293688-4201225X00000X
MN104982225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist