Provider Demographics
NPI:1871108316
Name:HOLLIFIELD, SHERIDAN DENAE (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:SHERIDAN
Middle Name:DENAE
Last Name:HOLLIFIELD
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 EMPORIA ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-1532
Mailing Address - Country:US
Mailing Address - Phone:918-351-4065
Mailing Address - Fax:
Practice Address - Street 1:4350 WILL ROGERS PKWY STE 600
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-1808
Practice Address - Country:US
Practice Address - Phone:405-246-6674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1434224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant