Provider Demographics
NPI:1255869244
Name:BUCHANAN, SHERRY MARIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:MARIE
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 CANDLE CT
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-2741
Mailing Address - Country:US
Mailing Address - Phone:937-248-9860
Mailing Address - Fax:
Practice Address - Street 1:140 EWOODBURY DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415
Practice Address - Country:US
Practice Address - Phone:937-938-1523
Practice Address - Fax:937-938-6877
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-02
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH05327224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant