Provider Demographics
NPI:1790997104
Name:WOOLLARD, SHERRY NICOLE (COTA)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:NICOLE
Last Name:WOOLLARD
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 1:7005 GREENHOLLY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-1609
Mailing Address - Country:US
Mailing Address - Phone:314-667-8485
Mailing Address - Fax:
Practice Address - Street 1:11701 BORMAN DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4100
Practice Address - Country:US
Practice Address - Phone:314-983-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000169643224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant