Provider Demographics
NPI:1225572316
Name:MORAN, SHERRI (COTA)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8811 MAPLE HILL DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-1754
Mailing Address - Country:US
Mailing Address - Phone:317-694-2023
Mailing Address - Fax:
Practice Address - Street 1:868 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:IN
Practice Address - Zip Code:46161-9633
Practice Address - Country:US
Practice Address - Phone:765-763-6012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32003096A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant