Provider Demographics
NPI:1821570805
Name:TYSON, SHERRY ALAN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:ALAN
Last Name:TYSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 S A ST
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638-3806
Mailing Address - Country:US
Mailing Address - Phone:559-673-9228
Mailing Address - Fax:
Practice Address - Street 1:517 S A ST
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638-3806
Practice Address - Country:US
Practice Address - Phone:559-644-7788
Practice Address - Fax:559-674-7199
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4857225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist