Basic Information
| Provider Information | |||||||||
| NPI: | 1518088210 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHARLEY | ||||||||
| FirstName: | JULIET | ||||||||
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| Credential: | M.S. OTR/L CHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4650 E COTTON CENTER BLVD STE 155 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850404803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028920915 | ||||||||
| FaxNumber: | 6029260910 | ||||||||
| Practice Location | |||||||||
| Address1: | 1355 S HIGLEY RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852964799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805078080 | ||||||||
| FaxNumber: | 4805078085 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2007 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | 225100000X | 2986 | AZ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | 2986 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 275109 | 05 | AZ | MEDICAID |