Provider Demographics
NPI:1407058522
Name:LEWIS, SHERRY W (COTA L)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:W
Last Name:LEWIS
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 1:280 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:TN
Mailing Address - Zip Code:37616-5932
Mailing Address - Country:US
Mailing Address - Phone:423-329-7878
Mailing Address - Fax:
Practice Address - Street 1:4850 E ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-3098
Practice Address - Country:US
Practice Address - Phone:423-787-6473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000700224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant