Provider Demographics
NPI:1386835304
Name:SHERROD, BRENDA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:SHERROD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:LORRAINE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:55 SAINT ROBERTS DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-3632
Mailing Address - Country:US
Mailing Address - Phone:540-657-6259
Mailing Address - Fax:
Practice Address - Street 1:55 SAINT ROBERTS DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-3632
Practice Address - Country:US
Practice Address - Phone:540-657-6259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003921225X00000X
NY012062-1225X00000X
DC225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist