Provider Demographics
NPI:1770602732
Name:LUMPKIN, SHERITA BUSH (OTR)
Entity type:Individual
Prefix:MS
First Name:SHERITA
Middle Name:BUSH
Last Name:LUMPKIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:SHERITA
Other - Middle Name:DENISE
Other - Last Name:BUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:509 15TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215-5336
Mailing Address - Country:US
Mailing Address - Phone:205-908-0184
Mailing Address - Fax:
Practice Address - Street 1:2200 RIVERCHASE CTR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-2866
Practice Address - Country:US
Practice Address - Phone:205-739-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0958225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist