Provider Demographics
NPI:1700667474
Name:MED PROS SHARE
Entity Type:Organization
Organization Name:MED PROS SHARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:906-361-7070
Mailing Address - Street 1:106 COLES DR
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4010
Mailing Address - Country:US
Mailing Address - Phone:906-629-1003
Mailing Address - Fax:
Practice Address - Street 1:106 COLES DR
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4010
Practice Address - Country:US
Practice Address - Phone:906-629-1003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty