Provider Demographics
NPI:1245563568
Name:CARSON, SHERRY DAWN
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:DAWN
Last Name:CARSON
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 1:8924 LATITUDES DR
Mailing Address - Street 2:APT 519
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8383
Mailing Address - Country:US
Mailing Address - Phone:317-345-3604
Mailing Address - Fax:
Practice Address - Street 1:8924 LATITUDES DR
Practice Address - Street 2:APT 519
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8383
Practice Address - Country:US
Practice Address - Phone:317-345-3604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32000644A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant