Provider Demographics
NPI:1649477886
Name:PACKER, SHARON LEE (COTA CERTIFIED OCCUP)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:LEE
Last Name:PACKER
Suffix:
Gender:F
Credentials:COTA CERTIFIED OCCUP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 GREAT WESTERN RD
Mailing Address - Street 2:
Mailing Address - City:HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02645-2428
Mailing Address - Country:US
Mailing Address - Phone:508-432-1582
Mailing Address - Fax:
Practice Address - Street 1:876 FALMOUTH RD
Practice Address - Street 2:LANDVIEW THERAPY RESOURCES PAVILION ESSEX
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601
Practice Address - Country:US
Practice Address - Phone:508-432-1582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1382224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1382OtherCOMMONWEALTH OF MA DIVISI