Provider Demographics
NPI:1295193662
Name:O'BANION, SHERRY PHONE TIP (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:PHONE TIP
Last Name:O'BANION
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:PHONE TIP
Other - Last Name:THENGKHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:11031 E 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-2634
Mailing Address - Country:US
Mailing Address - Phone:586-707-1183
Mailing Address - Fax:
Practice Address - Street 1:320 CHURCH ST.
Practice Address - Street 2:
Practice Address - City:MT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043
Practice Address - Country:US
Practice Address - Phone:248-689-0468
Practice Address - Fax:248-689-1068
Is Sole Proprietor?:No
Enumeration Date:2016-02-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213305224Z00000X
MI5202007792224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant