Provider Demographics
NPI:1306502158
Name:RICHMOND, SHARON LEE (LMT)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:LEE
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61513 RICHMOND WAY
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-5331
Mailing Address - Country:US
Mailing Address - Phone:541-294-8657
Mailing Address - Fax:
Practice Address - Street 1:61513 RICHMOND WAY
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-5331
Practice Address - Country:US
Practice Address - Phone:541-294-8657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26636225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty