Provider Demographics
NPI:1669108577
Name:DICKERSON, SIERA GRAYCE (OTR/L)
Entity type:Individual
Prefix:
First Name:SIERA
Middle Name:GRAYCE
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 TOWNSHIP ROAD 198
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-9207
Mailing Address - Country:US
Mailing Address - Phone:937-441-6267
Mailing Address - Fax:
Practice Address - Street 1:3218 INDIAN RIPPLE RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45440-3637
Practice Address - Country:US
Practice Address - Phone:937-426-8481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT012066225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist