Provider Demographics
NPI:1073933420
Name:CHERON, LAURA (OT/L)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CHERON
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11731 MOUNT OVERLOOK AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1025
Mailing Address - Country:US
Mailing Address - Phone:216-795-8092
Mailing Address - Fax:
Practice Address - Street 1:11731 MOUNT OVERLOOK AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-1025
Practice Address - Country:US
Practice Address - Phone:216-795-8092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT 003249225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics