Basic Information
| Provider Information | |||||||||
| NPI: | 1013426915 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHARRAH | ||||||||
| FirstName: | KYLA | ||||||||
| MiddleName: | KIMBERLY | ||||||||
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| Credential: | MOT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 113 KINGS MANOR CT | ||||||||
| Address2: | |||||||||
| City: | ST AUGUSTINE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320865283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173576595 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9141 CYPRESS GREEN DR STE 2 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322562006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046471849 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2017 | ||||||||
| LastUpdateDate: | 09/22/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225XP0200X | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.