Provider Demographics
NPI:1265106090
Name:SAMMONS, SHEENA LEE (OTR/L)
Entity type:Individual
Prefix:MS
First Name:SHEENA
Middle Name:LEE
Last Name:SAMMONS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9071 GEORGIAN CT
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-8605
Mailing Address - Country:US
Mailing Address - Phone:859-444-8300
Mailing Address - Fax:
Practice Address - Street 1:4250 GLENN AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41015-1641
Practice Address - Country:US
Practice Address - Phone:859-431-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY131942225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist