Provider Demographics
NPI:1184777583
Name:FLAHERTY, SHEILA MARIE (LR OT CHT)
Entity type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:MARIE
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:LR OT CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 KINGS HWY
Mailing Address - Street 2:APT 10C3
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33983-5291
Mailing Address - Country:US
Mailing Address - Phone:941-629-0390
Mailing Address - Fax:
Practice Address - Street 1:4161 TAMIAMI TRL
Practice Address - Street 2:UNIT 101
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9204
Practice Address - Country:US
Practice Address - Phone:941-625-0984
Practice Address - Fax:941-625-0877
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT601225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4639456OtherAETNA
FLDE0219OtherRR MEDICARE
FL77674OtherBCBS
FL0T601OtherPROVIDER LICENSE
FL0T601OtherPROVIDER LICENSE
FLZ9000ZMedicare ID - Type UnspecifiedMEDICARE
FL0886990001Medicare NSC