Provider Demographics
NPI:1508370461
Name:SHARER, JEROME MATTHEW
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:MATTHEW
Last Name:SHARER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2788 BALD EAGLE PIKE
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:PA
Mailing Address - Zip Code:16686-7726
Mailing Address - Country:US
Mailing Address - Phone:814-330-3716
Mailing Address - Fax:
Practice Address - Street 1:500 E MARYLYN AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-6269
Practice Address - Country:US
Practice Address - Phone:814-238-3322
Practice Address - Fax:814-941-7715
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC015376225100000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist