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NPI Code Detail

MEDICARE: MS. SHERRY WHIDDEN

MEDICARE: MS. SHERRY WHIDDEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy AssistantOTA000622FL

General Provider Information

NPI Number : 1023335809
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHERRY WHIDDEN
Provider Business Mailing Address
First Line : 105 N 5TH AVE
Second Line :
City : MADILL
State : OK
Zip : 73446-1200
Country : US
Telephone Number : 580-795-3301
Fax Number : 580-795-7307
Provider Business Practice Location Address
First Line : 16002 LAKESHORE VILLA DR
Second Line :
City : TAMPA
State : FL
Zip : 33613-1367
Country : US
Telephone Number : 580-795-3301
Fax Number : 580-795-7307
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2010
Last Update Date : 05/03/2010

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