Provider Demographics
NPI:1598822041
Name:ANTLEY, SHERRI JO
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:JO
Last Name:ANTLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHERRI
Other - Middle Name:
Other - Last Name:ANTLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:8928 PRISTINE CT
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5664
Mailing Address - Country:US
Mailing Address - Phone:704-236-3895
Mailing Address - Fax:
Practice Address - Street 1:8928 PRISTINE CT
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5664
Practice Address - Country:US
Practice Address - Phone:704-236-3895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5341225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211749Medicaid