Provider Demographics
NPI:1326236118
Name:FENTON, SHERLYN LOUISE (OTD,MS, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:SHERLYN
Middle Name:LOUISE
Last Name:FENTON
Suffix:
Gender:F
Credentials:OTD,MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MAN MAR DR
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02762-2271
Mailing Address - Country:US
Mailing Address - Phone:617-640-0400
Mailing Address - Fax:617-658-1049
Practice Address - Street 1:30 MAN MAR DR
Practice Address - Street 2:SUITE 9
Practice Address - City:PLAINVILLE
Practice Address - State:MA
Practice Address - Zip Code:02762-2271
Practice Address - Country:US
Practice Address - Phone:617-640-0400
Practice Address - Fax:617-658-1049
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2492171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAOT0055OtherBCBS
915892OtherNBCOT CERTIFICATION
S400284607OtherPTAN
RI1561OtherRI STATE LICENSE
MA2492OtherMA STATE OT LICENSE