Provider Demographics
NPI:1124642111
Name:RENFRO, SHARON M
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:M
Last Name:RENFRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:M
Other - Last Name:KAUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 GREENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-1426
Mailing Address - Country:US
Mailing Address - Phone:217-853-1673
Mailing Address - Fax:
Practice Address - Street 1:118 GREENRIDGE DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-1426
Practice Address - Country:US
Practice Address - Phone:217-853-1673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist