Provider Demographics
NPI:1467683409
Name:NISHIMURA, SHERI BURELL (OT, LMT)
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:BURELL
Last Name:NISHIMURA
Suffix:
Gender:F
Credentials:OT, LMT
Other - Prefix:
Other - First Name:SHERI
Other - Middle Name:LYNN
Other - Last Name:BURELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2415 CANTER DR
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-7477
Mailing Address - Country:US
Mailing Address - Phone:706-992-5868
Mailing Address - Fax:
Practice Address - Street 1:2357 WARM SPRINGS RD STE 120
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-5690
Practice Address - Country:US
Practice Address - Phone:706-325-2583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2346225X00000X
GAMT013598225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist