Provider Demographics
NPI:1871630053
Name:GANLEY, SHEILA (OTR/L, C/NDT)
Entity Type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:
Last Name:GANLEY
Suffix:
Gender:F
Credentials:OTR/L, C/NDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8081 N HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-7374
Mailing Address - Country:US
Mailing Address - Phone:573-673-1137
Mailing Address - Fax:573-441-1411
Practice Address - Street 1:8081 N HICKORY DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-7374
Practice Address - Country:US
Practice Address - Phone:573-673-1137
Practice Address - Fax:573-441-1411
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004953225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO475442422Medicaid