Provider Demographics
NPI:1164691523
Name:CHERRY, LAURA NEAL (MA, CRC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:NEAL
Last Name:CHERRY
Suffix:
Gender:F
Credentials:MA, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 GLENDON CT
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-3304
Mailing Address - Country:US
Mailing Address - Phone:614-776-1483
Mailing Address - Fax:614-776-3302
Practice Address - Street 1:2875 TIMBER RANGE CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-3174
Practice Address - Country:US
Practice Address - Phone:614-776-1483
Practice Address - Fax:614-776-3302
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00102706225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor