Provider Demographics
NPI:1104590777
Name:HENNINGER, SHARON (MSOT)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:HENNINGER
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1243
Mailing Address - Country:US
Mailing Address - Phone:859-625-2341
Mailing Address - Fax:
Practice Address - Street 1:241 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383
Practice Address - Country:US
Practice Address - Phone:859-625-2341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
KY274163225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist