Provider Demographics
NPI:1508502485
Name:SHERRILL, ANTONETTE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:ANTONETTE
Middle Name:
Last Name:SHERRILL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:ANTONETTE
Other - Middle Name:L
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:151 E MINNEHAHA AVE
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-3424
Mailing Address - Country:US
Mailing Address - Phone:352-394-2188
Mailing Address - Fax:
Practice Address - Street 1:151 E MINNEHAHA AVE
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-3424
Practice Address - Country:US
Practice Address - Phone:352-394-2188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA18648224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant