Provider Demographics
NPI:1295017200
Name:CANAL, SHERRY (OT)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:
Last Name:CANAL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 LOUISVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-6025
Mailing Address - Country:US
Mailing Address - Phone:318-323-8451
Mailing Address - Fax:318-361-2613
Practice Address - Street 1:1501 LOUISVILLE AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6025
Practice Address - Country:US
Practice Address - Phone:318-323-8451
Practice Address - Fax:318-361-2613
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z11366225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3C750Medicare PIN