Provider Demographics
NPI:1124396130
Name:KEMRY, CHERYL L (LMT)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:L
Last Name:KEMRY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60323 CINDER BUTTE RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-8960
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1288 SW SIMPSON AVE
Practice Address - Street 2:SUITE K
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3195
Practice Address - Country:US
Practice Address - Phone:541-617-9969
Practice Address - Fax:541-617-9890
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14884174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist