Provider Demographics
NPI:1972084184
Name:PROSPER, SHERRIE AMANDA (COTA)
Entity Type:Individual
Prefix:MRS
First Name:SHERRIE
Middle Name:AMANDA
Last Name:PROSPER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 W CUMBERLAND RD APT 108
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-5354
Mailing Address - Country:US
Mailing Address - Phone:903-641-8532
Mailing Address - Fax:
Practice Address - Street 1:2051 W CUMBERLAND RD APT 108
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-5354
Practice Address - Country:US
Practice Address - Phone:903-641-8532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-25
Last Update Date:2018-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213658224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant