Individual
SHARON LEE QUACO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
430 WEST CLEVELAND ROAD, APT.B23, GRANGER, IN 46530
(574) 243-9640
(574) 243-9640
Mailing address
22242 ROOSEVELT RD, SOUTH BEND, IN 46614-9261
(574) 299-0403
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31002026A
IN
Other
Enumeration date
12/24/2007
Last updated
12/24/2007
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