Provider Demographics
NPI:1770745549
Name:PROFFITT, SHERICA (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:SHERICA
Middle Name:
Last Name:PROFFITT
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 1:214 FAIRCREST WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9243
Mailing Address - Country:US
Mailing Address - Phone:803-234-5620
Mailing Address - Fax:
Practice Address - Street 1:214 FAIRCREST WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-9243
Practice Address - Country:US
Practice Address - Phone:803-234-5620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3115225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist