Provider Demographics
NPI:1194274563
Name:TRAGER, SHARON (MSOT, OTR/L)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:TRAGER
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 OLD TUSCULUM RD
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-4309
Mailing Address - Country:US
Mailing Address - Phone:323-459-2600
Mailing Address - Fax:
Practice Address - Street 1:401 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-4877
Practice Address - Country:US
Practice Address - Phone:423-722-2062
Practice Address - Fax:423-722-2063
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5525225X00000X
CA15800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist