Provider Demographics
NPI:1639311772
Name:JOHNS, SHERRY EVELYN (COTA/L)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:EVELYN
Last Name:JOHNS
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 1:2250 PEACHLEAF CT
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-7001
Mailing Address - Country:US
Mailing Address - Phone:407-804-1366
Mailing Address - Fax:
Practice Address - Street 1:5433 W STATE ROAD 46
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-9236
Practice Address - Country:US
Practice Address - Phone:407-324-7204
Practice Address - Fax:407-324-7204
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA10022224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant