Provider Demographics
NPI:1699951442
Name:HOLMER, SHARON LYNN (OTR/L)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:LYNN
Last Name:HOLMER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11125 E 300TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:IL
Mailing Address - Zip Code:62427-2004
Mailing Address - Country:US
Mailing Address - Phone:618-584-3457
Mailing Address - Fax:
Practice Address - Street 1:11125 E 300TH AVE
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:IL
Practice Address - Zip Code:62427-2004
Practice Address - Country:US
Practice Address - Phone:618-584-3457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist