Provider Demographics
NPI:1972788487
Name:MARTIN, SHARON JO (LMT)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:JO
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:JO
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:N8210 HIGHWAY 89
Mailing Address - Street 2:
Mailing Address - City:WHITEWATER
Mailing Address - State:WI
Mailing Address - Zip Code:53190-4100
Mailing Address - Country:US
Mailing Address - Phone:262-472-0718
Mailing Address - Fax:
Practice Address - Street 1:435 W STARIN RD
Practice Address - Street 2:112 AA
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-1133
Practice Address - Country:US
Practice Address - Phone:262-472-0718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist