Provider Demographics
NPI:1386092260
Name:MILLS, SHERESA (OTR)
Entity type:Individual
Prefix:
First Name:SHERESA
Middle Name:
Last Name:MILLS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 BALTIMORE ANNAPOLIS BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3956
Mailing Address - Country:US
Mailing Address - Phone:410-544-2500
Mailing Address - Fax:410-384-9703
Practice Address - Street 1:500 CAROLINA MDWS
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-8471
Practice Address - Country:US
Practice Address - Phone:919-904-7059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD355700225X00000X
NC10752225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist