Provider Demographics
NPI:1841758877
Name:SHERRY, DAKOTA RICHMOND
Entity Type:Individual
Prefix:
First Name:DAKOTA
Middle Name:RICHMOND
Last Name:SHERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1192 166TH DR
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-7387
Mailing Address - Country:US
Mailing Address - Phone:515-230-5989
Mailing Address - Fax:
Practice Address - Street 1:1192 166TH DR
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-7387
Practice Address - Country:US
Practice Address - Phone:515-230-5989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer