Provider Demographics
NPI:1669606638
Name:NINEDORF, SHARON (OT/L)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:NINEDORF
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:KLINGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT/L
Mailing Address - Street 1:3825 ROLLING ACRES DRIVE
Mailing Address - Street 2:
Mailing Address - City:SUGAR CAMP
Mailing Address - State:WI
Mailing Address - Zip Code:54501-8876
Mailing Address - Country:US
Mailing Address - Phone:715-499-2173
Mailing Address - Fax:
Practice Address - Street 1:3825 ROLLING ACRES DR
Practice Address - Street 2:
Practice Address - City:SUGAR CAMP
Practice Address - State:WI
Practice Address - Zip Code:54501-8682
Practice Address - Country:US
Practice Address - Phone:715-499-2173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4757-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist