Provider Demographics
NPI:1659868636
Name:SHERMAN, ELISABETH LEANNE
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:LEANNE
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W941 DU BORG RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:WI
Mailing Address - Zip Code:53925-9540
Mailing Address - Country:US
Mailing Address - Phone:269-281-1790
Mailing Address - Fax:
Practice Address - Street 1:W941 DU BORG RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:WI
Practice Address - Zip Code:53925-9540
Practice Address - Country:US
Practice Address - Phone:269-281-1790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6277-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist