Provider Demographics
NPI:1043042401
Name:SHRADER, SOPHIA (OTR/L)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:SHRADER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:
Other - Last Name:MAROTTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2005 VISCOUNT DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-7029
Mailing Address - Country:US
Mailing Address - Phone:315-748-0844
Mailing Address - Fax:
Practice Address - Street 1:1140 TURNBRIDGE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-5862
Practice Address - Country:US
Practice Address - Phone:919-260-8438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17077225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist