Provider Demographics
NPI:1770533820
Name:MIESNER, SHARON (OT)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:MIESNER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 11230
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-1230
Mailing Address - Country:US
Mailing Address - Phone:479-709-7000
Mailing Address - Fax:479-709-7051
Practice Address - Street 1:3501 W. E. KNIGHT DRIVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903
Practice Address - Country:US
Practice Address - Phone:479-709-7000
Practice Address - Fax:479-709-7051
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT153225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U321OtherAR BLUE CROSS BLUE SHIELD
AR137402721Medicaid
AR5U321OtherAR BLUE CROSS BLUE SHIELD
ARS84069Medicare UPIN