Provider Demographics
NPI:1821505249
Name:SHERIDAN, TIMOTHY (OT/L)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:SHERIDAN
Suffix:
Gender:M
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 EDWARDS MILL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5243
Mailing Address - Country:US
Mailing Address - Phone:919-781-4060
Mailing Address - Fax:919-863-6821
Practice Address - Street 1:781 AVENT FERRY RD STE 110
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-7776
Practice Address - Country:US
Practice Address - Phone:919-781-4060
Practice Address - Fax:919-781-5246
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17795225X00000X
NC16338225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist