Sherry Phone Tip O'Banion, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

5202007792 Issued in MI

Practice address

320 Church St.
Mt Clemens, MI 48043

Phone

(248) 689-0468

Fax

(248) 689-1068

NPI assigned

Feb 1, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Sherry Phone Tip Thengkham Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1454284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661990400000",
    "number": "1295193662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11031 E 12 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480932634",
            "telephone_number": "586-707-1183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 CHURCH ST.",
            "city": "MT CLEMENS",
            "state": "MI",
            "postal_code": "48043",
            "telephone_number": "248-689-0468",
            "fax_number": "248-689-1068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'BANION",
        "first_name": "SHERRY",
        "middle_name": "PHONE TIP",
        "name_prefix": "Mrs.",
        "credential": "COTA/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-01",
        "last_updated": "2022-09-01",
        "certification_date": "2022-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "TX",
            "license": "213305",
            "primary": false
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "MI",
            "license": "5202007792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHERRY",
            "last_name": "THENGKHAM",
            "middle_name": "PHONE TIP",
            "credential": "COTA/L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Xavier Nelson
• New Passages
• Gratino Ngassa Kampie
• Kathy Nicholas
• Kristin Nobles, LLMSW
• Kaylyn Rose O'Connor, LLMSW
• Michael J O'Connor, D.D.S.
• Mya Obeney
• Amanda Obi, DO
• Observation Physicians of Macomb PLLC

• Occupational Therapy Assistant in Mt Clemens, MI
• Providers in Mt Clemens, MI by specialty
• Occupational Therapy Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.