Provider Demographics
NPI:1891990891
Name:SHIDEL, KERRY (OT/L)
Entity Type:Individual
Prefix:MR
First Name:KERRY
Middle Name:
Last Name:SHIDEL
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 1:10325 WANDA CIR NE
Mailing Address - Street 2:
Mailing Address - City:HARTVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44632-9776
Mailing Address - Country:US
Mailing Address - Phone:330-936-2200
Mailing Address - Fax:
Practice Address - Street 1:5000 ROCKSIDE RD STE 400
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-6826
Practice Address - Country:US
Practice Address - Phone:216-642-6044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT-003737225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist