Provider Demographics
NPI:1407299159
Name:SHERMAN, MOLLIE LAUREN (OTR/L)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:LAUREN
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MOLLIE
Other - Middle Name:LAUREN
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:60 E LINDEN AVE APT 6D
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3652
Mailing Address - Country:US
Mailing Address - Phone:347-884-3666
Mailing Address - Fax:
Practice Address - Street 1:60 E LINDEN AVE APT 6D
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3652
Practice Address - Country:US
Practice Address - Phone:347-884-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ325076174N00000X
NJ46TR00702600225X00000X, 225XH1200X
NY017965225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist