Provider Demographics
NPI:1245026434
Name:FORD, SHERRI LEE (COTA/L)
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:LEE
Last Name:FORD
Suffix:
Gender:
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 1:8100 MEDICINE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55427-3404
Mailing Address - Country:US
Mailing Address - Phone:763-334-4409
Mailing Address - Fax:
Practice Address - Street 1:8100 MEDICINE LAKE RD
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55427-3404
Practice Address - Country:US
Practice Address - Phone:763-334-4409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN200210224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant