Provider Demographics
NPI:1164611869
Name:RUSSAK, SHERRY LYNN (OT)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:LYNN
Last Name:RUSSAK
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MRS
Other - First Name:SHERRY
Other - Middle Name:LYNN
Other - Last Name:RUSSAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:253 LAKEFRONT BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-4316
Mailing Address - Country:US
Mailing Address - Phone:716-854-1790
Mailing Address - Fax:716-662-5700
Practice Address - Street 1:253 LAKEFRONT BLVD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-4316
Practice Address - Country:US
Practice Address - Phone:716-854-1790
Practice Address - Fax:716-662-5700
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006223-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist