Provider Demographics
NPI:1942519251
Name:HORVATH, SHERRY ELAINE (COTA/L)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:ELAINE
Last Name:HORVATH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 LEWIS DR
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-8509
Mailing Address - Country:US
Mailing Address - Phone:913-306-2448
Mailing Address - Fax:
Practice Address - Street 1:910 LEWIS DR
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-8509
Practice Address - Country:US
Practice Address - Phone:913-306-2448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-00484320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness