Provider Demographics
NPI:1154626224
Name:SANDERSON, SHARON DIANE (OT)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:DIANE
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 E. UMPHRESS
Mailing Address - Street 2:P.O. BOX 758
Mailing Address - City:VAN ALSTYNE
Mailing Address - State:TX
Mailing Address - Zip Code:75495-0758
Mailing Address - Country:US
Mailing Address - Phone:903-482-6822
Mailing Address - Fax:
Practice Address - Street 1:249 E. UMPHRESS
Practice Address - Street 2:
Practice Address - City:VAN ALSTYNE
Practice Address - State:TX
Practice Address - Zip Code:75495-0758
Practice Address - Country:US
Practice Address - Phone:903-482-6822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107302225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist