Provider Demographics
NPI:1912367723
Name:SHERI'S OCCUPATIONAL THERAPY SERVICES
Entity Type:Organization
Organization Name:SHERI'S OCCUPATIONAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:GENOVESE
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OTR/L
Authorized Official - Phone:619-838-7460
Mailing Address - Street 1:16166 CAYENNE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3707
Mailing Address - Country:US
Mailing Address - Phone:619-838-7460
Mailing Address - Fax:
Practice Address - Street 1:1615 S RANCHO SANTA FE RD
Practice Address - Street 2:SUITE A
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-5194
Practice Address - Country:US
Practice Address - Phone:619-838-7460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA414032251P0200X
CAOT 8656225XF0002X
CAOT8656225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & SwallowingGroup - Multi-Specialty