MEDICARE: SHERYL PERRY

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
1	225X00000X	Occupational Therapist	OC011059	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OC011059	OTHER	PA	OT LICENSE

General Provider Information

NPI Number	:	1407275522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERYL PERRY

Provider Business Mailing Address
First Line	:	7146 SHELBOURNE ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19111-3936
Country	:	US
Telephone Number	:	484-681-1154
Fax Number	:

Provider Business Practice Location Address
First Line	:	7146 SHELBOURNE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-3936
Country	:	US
Telephone Number	:	484-681-1154
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2014
Last Update Date	:	04/16/2014

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