1326236118 NPI number — MS. SHERLYN LOUISE FENTON OTD,MS, OTR/L

Table of content: MS. SHERLYN LOUISE FENTON OTD,MS, OTR/L (NPI 1326236118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326236118 NPI number — MS. SHERLYN LOUISE FENTON OTD,MS, OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FENTON
Provider First Name:
SHERLYN
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTD,MS, OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326236118
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 MAN MAR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLAINVILLE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02762-2271
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-640-0400
Provider Business Mailing Address Fax Number:
617-658-1049

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 MAN MAR DR
Provider Second Line Business Practice Location Address:
SUITE 9
Provider Business Practice Location Address City Name:
PLAINVILLE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02762-2271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-640-0400
Provider Business Practice Location Address Fax Number:
617-658-1049
Provider Enumeration Date:
10/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171W00000X , with the licence number:  2492 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: OT0055 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 915892 . This is a "NBCOT CERTIFICATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: S400284607 . This is a "PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1561 . This is a "RI STATE LICENSE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 2492 . This is a "MA STATE OT LICENSE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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