Provider Demographics
NPI:1770733016
Name:MATHIS, SHERRI D (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:D
Last Name:MATHIS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 STEWART ST
Mailing Address - Street 2:
Mailing Address - City:CARMI
Mailing Address - State:IL
Mailing Address - Zip Code:62821-1253
Mailing Address - Country:US
Mailing Address - Phone:618-382-8020
Mailing Address - Fax:
Practice Address - Street 1:901 STEWART ST
Practice Address - Street 2:
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821-1253
Practice Address - Country:US
Practice Address - Phone:618-382-8020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007357225X00000X
IN31004499A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist