Provider Demographics
NPI:1366471120
Name:BOOTHBY, SHERRY M (OTRL)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:M
Last Name:BOOTHBY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DAVIS POINT LN UNIT 1A
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-2628
Mailing Address - Country:US
Mailing Address - Phone:207-767-9773
Mailing Address - Fax:207-415-9212
Practice Address - Street 1:2 DAVIS POINT LN UNIT 1A
Practice Address - Street 2:
Practice Address - City:CAPE ELIZABETH
Practice Address - State:ME
Practice Address - Zip Code:04107
Practice Address - Country:US
Practice Address - Phone:207-767-9773
Practice Address - Fax:207-415-9212
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT569225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME135101OtherMEDICARE PTAN
MEME1351Medicare ID - Type Unspecified