Provider Demographics
NPI:1245543156
Name:REYNOLDS, SHERRY A (COTA)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:A
Last Name:REYNOLDS
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 1:18574 PANER DR.
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062
Mailing Address - Country:US
Mailing Address - Phone:260-246-9441
Mailing Address - Fax:765-683-0633
Practice Address - Street 1:449 MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-1185
Practice Address - Country:US
Practice Address - Phone:765-683-0633
Practice Address - Fax:765-683-0603
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001652A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant