Provider Demographics
NPI:1104222546
Name:SPAULDING, CHERYL (OTR/L)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:SPAULDING
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 1:620 MACDUFF AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-1840
Mailing Address - Country:US
Mailing Address - Phone:209-478-4848
Mailing Address - Fax:
Practice Address - Street 1:620 MACDUFF AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-1840
Practice Address - Country:US
Practice Address - Phone:209-478-4848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 2371225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist