Provider Demographics
NPI:1831393693
Name:ROBERTS, SHARON (COTA-L)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:COTA-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 MANSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ASHFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06278-1416
Mailing Address - Country:US
Mailing Address - Phone:860-208-2265
Mailing Address - Fax:
Practice Address - Street 1:97 PRESTON RD
Practice Address - Street 2:
Practice Address - City:GRISWOLD
Practice Address - State:CT
Practice Address - Zip Code:06351-2516
Practice Address - Country:US
Practice Address - Phone:860-376-4438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000443224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant