Provider Demographics
NPI:1669504254
Name:GAITER, SHARON (OTR)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:GAITER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 CHURCH LN
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-4720
Mailing Address - Country:US
Mailing Address - Phone:770-459-6533
Mailing Address - Fax:678-666-5565
Practice Address - Street 1:2001 CHURCH LN
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-4720
Practice Address - Country:US
Practice Address - Phone:770-459-6533
Practice Address - Fax:678-666-5565
Is Sole Proprietor?:No
Enumeration Date:2007-03-10
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT001137225X00000X
FLOT12121225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA362087OtherWELLCARE OF GEORGIA
GA00595779GOtherPEACHSTATE
GA600110OtherBLUE CROSS BLUE SHIELD
GA00595779GMedicaid
GA10052033OtherAMERIGROUP OF GEORGIA