Provider Demographics
NPI:1861787889
Name:MORTOLA, SHERI MARIE (OTR/L, SWC)
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:MARIE
Last Name:MORTOLA
Suffix:
Gender:F
Credentials:OTR/L, SWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776 SERRANO DR
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1754
Mailing Address - Country:US
Mailing Address - Phone:805-440-6411
Mailing Address - Fax:
Practice Address - Street 1:776 SERRANO DR
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1754
Practice Address - Country:US
Practice Address - Phone:805-440-6411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4531225XF0002X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing