Provider Demographics
NPI:1265884803
Name:AUTMAN, SHARON (LMT)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:AUTMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1699 WALL ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-6213
Mailing Address - Country:US
Mailing Address - Phone:847-627-8811
Mailing Address - Fax:224-404-4182
Practice Address - Street 1:1699 WALL ST
Practice Address - Street 2:SUITE 106
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-6213
Practice Address - Country:US
Practice Address - Phone:847-627-8811
Practice Address - Fax:224-404-4182
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227013796173C00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist