Provider Demographics
NPI:1851059265
Name:SOMERS, SHELDON CAROLE (OTR)
Entity Type:Individual
Prefix:
First Name:SHELDON
Middle Name:CAROLE
Last Name:SOMERS
Suffix:
Gender:F
Credentials:OTR
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 170606
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-0030
Mailing Address - Country:US
Mailing Address - Phone:864-591-3484
Mailing Address - Fax:864-641-7650
Practice Address - Street 1:128 GARNER RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3149
Practice Address - Country:US
Practice Address - Phone:864-591-3484
Practice Address - Fax:864-641-7650
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6356225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6356OtherSC LICENSE