Provider Demographics
NPI:1528470796
Name:SHERMAN, ANNA M (OT)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:M
Other - Last Name:HEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:N2950 STATE ROAD 67
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-2655
Mailing Address - Country:US
Mailing Address - Phone:262-245-4980
Mailing Address - Fax:262-245-2248
Practice Address - Street 1:N2950 STATE ROAD 67
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-2655
Practice Address - Country:US
Practice Address - Phone:262-245-4980
Practice Address - Fax:262-245-2248
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4550-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIHEADANNOtherMERCYCARE INSURANCE
WI000054176-K400147037OtherWI MEDICARE
WI1528470796Medicaid
WI1528470796OtherBCBSWI
WI1528470796Medicaid