Provider Demographics
NPI:1750698346
Name:SHERSHOW, SUSAN (OT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SHERSHOW
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MORTLAND RD
Mailing Address - Street 2:RSU20 SPECIAL SERVICES OFFICE
Mailing Address - City:SEARSPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04974-3332
Mailing Address - Country:US
Mailing Address - Phone:207-548-6643
Mailing Address - Fax:
Practice Address - Street 1:56 BAYSIDE RD
Practice Address - Street 2:EDNA DRINKWATER SCHOOL
Practice Address - City:NORTHPORT
Practice Address - State:ME
Practice Address - Zip Code:04849-4435
Practice Address - Country:US
Practice Address - Phone:207-338-3430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME66225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics