Provider Demographics
NPI:1669194353
Name:OLIVER, SHARON
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:OH
Mailing Address - Zip Code:44612-0146
Mailing Address - Country:US
Mailing Address - Phone:330-323-0662
Mailing Address - Fax:330-639-4747
Practice Address - Street 1:513 GOBEL AVE SE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44707-2721
Practice Address - Country:US
Practice Address - Phone:330-323-0662
Practice Address - Fax:330-639-4747
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness