Provider Demographics
NPI:1790010411
Name:NOLTING, SHERI LYNN (MSOTR)
Entity Type:Individual
Prefix:MRS
First Name:SHERI
Middle Name:LYNN
Last Name:NOLTING
Suffix:
Gender:F
Credentials:MSOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11824 E BASE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-9600
Mailing Address - Country:US
Mailing Address - Phone:812-579-5620
Mailing Address - Fax:812-579-5620
Practice Address - Street 1:11824 E BASE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-9600
Practice Address - Country:US
Practice Address - Phone:812-579-5620
Practice Address - Fax:812-579-5620
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002377A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200712600Medicaid