Provider Demographics
NPI:1114142445
Name:NELSON, CHERYL S (OT)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:S
Last Name:NELSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29870
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9870
Mailing Address - Country:US
Mailing Address - Phone:602-772-3805
Mailing Address - Fax:602-772-3801
Practice Address - Street 1:10450 W MCDOWELL RD
Practice Address - Street 2:STE 102
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-4802
Practice Address - Country:US
Practice Address - Phone:623-848-4687
Practice Address - Fax:623-848-4686
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00845668OtherRAILROAD MEDICARE
3Z3990OtherHEALTHNET ID
AZ637738Medicaid
AZP00845668OtherRAILROAD MEDICARE