Provider Demographics
NPI:1942426473
Name:MAGEE, SHARON FAYE I (MSWOTRL)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:FAYE
Last Name:MAGEE
Suffix:I
Gender:F
Credentials:MSWOTRL
Other - Prefix:MS
Other - First Name:SHERRY
Other - Middle Name:FAYE
Other - Last Name:MAGEE
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:MSWOTRL
Mailing Address - Street 1:2107 CALLE TECOLOTE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5731
Mailing Address - Country:US
Mailing Address - Phone:505-470-6977
Mailing Address - Fax:505-986-9113
Practice Address - Street 1:2107 CALLE TECOLOTE
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5731
Practice Address - Country:US
Practice Address - Phone:505-470-6977
Practice Address - Fax:505-986-9113
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM#122224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMD2366Medicaid