Provider Demographics
NPI:1609947563
Name:MCCULLOUGH, SHEILA G (OTR, CHT)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:G
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 LYE BROOK RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05255-9544
Mailing Address - Country:US
Mailing Address - Phone:802-558-3840
Mailing Address - Fax:
Practice Address - Street 1:5100 SHARON RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-4768
Practice Address - Country:US
Practice Address - Phone:802-558-3840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1569225X00000X
VT072-0000099225XH1200X
MA3736225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008974Medicaid
VT4608590001Medicare NSC
VT1008974Medicaid