Provider Demographics
NPI:1316900913
Name:NOLAN, SHARON M (OTR/CHT)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:M
Last Name:NOLAN
Suffix:
Gender:F
Credentials:OTR/CHT
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:M
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:807 W LUTHER AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:PA
Mailing Address - Zip Code:15946-2179
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3200 PLEASANT VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4310
Practice Address - Country:US
Practice Address - Phone:814-949-9500
Practice Address - Fax:814-949-9550
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002381L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA780142Medicare ID - Type UnspecifiedMEDICARE #