Provider Demographics
NPI:1962783043
Name:ROSENBERG, SHARON NICHELLE (MOT)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:NICHELLE
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:NICHELLE
Other - Last Name:LESCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13020 N TELECOM PKWY
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-0925
Mailing Address - Country:US
Mailing Address - Phone:813-978-9700
Mailing Address - Fax:
Practice Address - Street 1:7525 NW 4TH BLVD STE 90
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-1846
Practice Address - Country:US
Practice Address - Phone:352-744-7868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT14739225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004291700Medicaid
FL169704439OtherMEDICARE PTAN
FL1376593053OtherGROUP PRACTICE NPI