Provider Demographics
NPI:1952522682
Name:KITSONAS, SHARON LESLIE (CRC)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:LESLIE
Last Name:KITSONAS
Suffix:
Gender:F
Credentials:CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11741 COVENTRY AVE
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-8488
Mailing Address - Country:US
Mailing Address - Phone:614-868-0546
Mailing Address - Fax:614-868-8969
Practice Address - Street 1:11741 COVENTRY AVE
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-8488
Practice Address - Country:US
Practice Address - Phone:614-868-0546
Practice Address - Fax:614-868-8969
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00006443225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner