Provider Demographics
NPI:1912056219
Name:CROSSETT, SHARON (OTRL)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:CROSSETT
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2474 E JOYCE BLVD
Mailing Address - Street 2:STE 2
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4519
Mailing Address - Country:US
Mailing Address - Phone:479-521-5326
Mailing Address - Fax:479-521-5429
Practice Address - Street 1:2474 E JOYCE BLVD
Practice Address - Street 2:STE 2
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4519
Practice Address - Country:US
Practice Address - Phone:479-521-5326
Practice Address - Fax:479-521-5429
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR239225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5W238OtherBLUE CROSS BLUE SHIELD PR