Provider Demographics
NPI:1801815097
Name:HENTZ, SHERI F (OT)
Entity Type:Individual
Prefix:MS
First Name:SHERI
Middle Name:F
Last Name:HENTZ
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:PO BOX 13550
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85216-3550
Mailing Address - Country:US
Mailing Address - Phone:480-325-3801
Mailing Address - Fax:480-325-3805
Practice Address - Street 1:6309 E BAYWOOD AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1744
Practice Address - Country:US
Practice Address - Phone:480-325-3801
Practice Address - Fax:480-325-3805
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0469225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
75972Medicare ID - Type Unspecified