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General NPI Number Information
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NPI Number | 1891990891
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Entity Type | Individual
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Provider Name | KERRY SHIDEL OT/L
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Gender | Male
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 04/30/2019
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Provider Practice Location Address
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Address Line | 5000 ROCKSIDE RD STE 400
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City | INDEPENDENCE
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State | OH
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Zip | 44131-6826
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Country | US
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Telephone | 216-642-6044
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Fax |
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Provider Business Mailing Address
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Address Line | 10325 WANDA CIR NE
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City | HARTVILLE
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State | OH
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Zip | 44632-9776
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Country | US
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Telephone | 330-936-2200
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Fax |
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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 | OT-003737
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License Number State | OH
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