Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT-2766 | OH |
NPI | 1043975121 |
---|---|
Provider Name | Dr. Kevin Sheridan |
First Address | Warsaw, OH 43844-9006 |
Second Address | Warsaw, OH 43844-9006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2021 |
Last Update Date | 03/11/2021 |