Provider Demographics
NPI:1770698847
Name:GUEBERT, SHARON (OTR)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:GUEBERT
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 1:12017 RAYO DE LUNA LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732-1975
Mailing Address - Country:US
Mailing Address - Phone:512-266-8979
Mailing Address - Fax:
Practice Address - Street 1:711 W 38TH ST
Practice Address - Street 2:BLDG B-4
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1121
Practice Address - Country:US
Practice Address - Phone:512-452-6475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101652OtherLICENSE #