Provider Demographics
NPI:1679824106
Name:PATILLO, SHERRI JO (COTA)
Entity Type:Individual
Prefix:MRS
First Name:SHERRI
Middle Name:JO
Last Name:PATILLO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1782 N 800 E
Mailing Address - Street 2:
Mailing Address - City:AVILLA
Mailing Address - State:IN
Mailing Address - Zip Code:46710-9626
Mailing Address - Country:US
Mailing Address - Phone:260-349-5067
Mailing Address - Fax:
Practice Address - Street 1:1782 N 800 E
Practice Address - Street 2:
Practice Address - City:AVILLA
Practice Address - State:IN
Practice Address - Zip Code:46710-9626
Practice Address - Country:US
Practice Address - Phone:260-349-5067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001721A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant