Provider Demographics
NPI:1245664242
Name:HARDEE, SHERIA ANN (OTR)
Entity type:Individual
Prefix:MRS
First Name:SHERIA
Middle Name:ANN
Last Name:HARDEE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3207 MESENA LN
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-9658
Mailing Address - Country:US
Mailing Address - Phone:706-854-0640
Mailing Address - Fax:706-854-0641
Practice Address - Street 1:3207 MESENA LN
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-9658
Practice Address - Country:US
Practice Address - Phone:706-854-0640
Practice Address - Fax:706-854-0641
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT000299225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA156458561AMedicaid
GA67BBBJWMedicare PIN