Provider Demographics
NPI:1073560215
Name:UPSHAW, SHERIDA FAYE (COTA)
Entity Type:Individual
Prefix:MS
First Name:SHERIDA
Middle Name:FAYE
Last Name:UPSHAW
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:SHERIDA
Other - Middle Name:F
Other - Last Name:BIRCHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5214 S EAST STREET
Mailing Address - Street 2:BUILDING D STE 1
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227
Mailing Address - Country:US
Mailing Address - Phone:800-486-4449
Mailing Address - Fax:317-780-3750
Practice Address - Street 1:5214 S EAST STREET
Practice Address - Street 2:BUILDING D STE 1HTS OUTPATIENT THERAPY SERVICES
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227
Practice Address - Country:US
Practice Address - Phone:800-486-4449
Practice Address - Fax:317-780-3750
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant