Provider Demographics
NPI:1043975121
Name:SHERIDAN, KEVIN (OT)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:SHERIDAN
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18160 COUNTY ROAD 54
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:OH
Mailing Address - Zip Code:43844-9006
Mailing Address - Country:US
Mailing Address - Phone:740-601-1639
Mailing Address - Fax:
Practice Address - Street 1:18160 COUNTY ROAD 54
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:OH
Practice Address - Zip Code:43844-9006
Practice Address - Country:US
Practice Address - Phone:740-601-1639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT-2766225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology