Provider Demographics
NPI:1518733179
Name:SHERRARD, MALLORY (COTA/L)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:SHERRARD
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:PO BOX 540
Mailing Address - Street 2:
Mailing Address - City:SINCLAIRVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14782-0540
Mailing Address - Country:US
Mailing Address - Phone:716-962-5155
Mailing Address - Fax:
Practice Address - Street 1:43 SINCLAIR DR
Practice Address - Street 2:
Practice Address - City:SINCLAIRVILLE
Practice Address - State:NY
Practice Address - Zip Code:14782-9637
Practice Address - Country:US
Practice Address - Phone:716-962-5195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011487224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty