Provider Demographics
NPI:1801032370
Name:BUCHANAN, SHERRI A (OT)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:A
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 N 1ST ST
Mailing Address - Street 2:P. O. BOX 95
Mailing Address - City:VIENNA
Mailing Address - State:IL
Mailing Address - Zip Code:62995-1544
Mailing Address - Country:US
Mailing Address - Phone:618-658-8144
Mailing Address - Fax:618-658-9146
Practice Address - Street 1:811 N 1ST ST
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:IL
Practice Address - Zip Code:62995-1544
Practice Address - Country:US
Practice Address - Phone:618-658-8144
Practice Address - Fax:618-658-9146
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056006287225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist