Provider Demographics
NPI:1972869287
Name:WELLS, SHARRON ROSE (COTA)
Entity Type:Individual
Prefix:
First Name:SHARRON
Middle Name:ROSE
Last Name:WELLS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6376 QUAIL RUN DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-2811
Mailing Address - Country:US
Mailing Address - Phone:269-544-3764
Mailing Address - Fax:269-544-3767
Practice Address - Street 1:6376 QUAIL RUN DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2811
Practice Address - Country:US
Practice Address - Phone:269-544-3764
Practice Address - Fax:269-544-3767
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202006997224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant