Provider Demographics
NPI:1750539417
Name:WISNIESKI, SHARON A (OT)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:A
Last Name:WISNIESKI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12928 BLOOMFIELD HILLS LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732-2066
Mailing Address - Country:US
Mailing Address - Phone:512-291-3452
Mailing Address - Fax:512-535-6786
Practice Address - Street 1:3303 NORTHLAND DR
Practice Address - Street 2:SUITE 214
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4945
Practice Address - Country:US
Practice Address - Phone:512-619-0303
Practice Address - Fax:512-291-2666
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109863225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics