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General NPI Number Information
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NPI Number | 1821505249
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Entity Type | Individual
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Provider Name | TIMOTHY SHERIDAN OT/L
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Gender | Male
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Dates
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Enumeration Date | 01/08/2018
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Last Update Date | 10/10/2023
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Provider Practice Location Address
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Address Line | 781 AVENT FERRY RD STE 110
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540-7776
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Country | US
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Telephone | 919-781-4060
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Fax | 919-781-5246
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Provider Business Mailing Address
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Address Line | 3001 EDWARDS MILL RD STE 200
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City | RALEIGH
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State | NC
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Zip | 27612-5243
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Country | US
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Telephone | 919-781-4060
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Fax | 919-863-6821
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 17795
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 16338
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License Number State | NC
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