Provider Demographics
NPI:1396274577
Name:SHELDON, OLIVIA ROSE (MS, OT)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ROSE
Last Name:SHELDON
Suffix:
Gender:F
Credentials:MS, OT
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:ROSE
Other - Last Name:ROACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:937 MORGAN RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:NY
Mailing Address - Zip Code:13112-8744
Mailing Address - Country:US
Mailing Address - Phone:607-244-6084
Mailing Address - Fax:
Practice Address - Street 1:20 MANOR DR
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-6495
Practice Address - Country:US
Practice Address - Phone:315-349-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP06220225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist