Provider Demographics
NPI:1093758468
Name:KUTCHER, SHERYLL DAWN
Entity Type:Individual
Prefix:MRS
First Name:SHERYLL
Middle Name:DAWN
Last Name:KUTCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 STONE RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-5724
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3465 BOX HILL CORPORATE CENTER DR
Practice Address - Street 2:SUITE G
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-1261
Practice Address - Country:US
Practice Address - Phone:410-569-4806
Practice Address - Fax:410-569-5474
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02779225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD51647OtherUSFHP, KAISER, EHP
MD51647OtherPRIORITY PARTNERS
PWP00292193OtherMEDICARE RAILROAD
MD2144336OtherALLIANCE
MD61230802OtherBCBS
MDT121-0008OtherFED BCBS, BLUECHOICE
MD0007857635OtherAETNA
MD4846270001OtherDME POS ASSIGNED
MDT121-0008OtherFED BCBS, BLUECHOICE
MDQ41900Medicare UPIN