Provider Demographics
NPI:1215036975
Name:PAETH, CHERYL A (OTR/L, OTD)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:A
Last Name:PAETH
Suffix:
Gender:F
Credentials:OTR/L, OTD
Other - Prefix:MS
Other - First Name:CHERYL
Other - Middle Name:A
Other - Last Name:KARL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD, OTR/L
Mailing Address - Street 1:1589 COUNTY ROAD 90
Mailing Address - Street 2:
Mailing Address - City:GIBSONBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43431-9718
Mailing Address - Country:US
Mailing Address - Phone:419-205-3659
Mailing Address - Fax:
Practice Address - Street 1:3557 US HIGHWAY 20 W
Practice Address - Street 2:
Practice Address - City:LINDSEY
Practice Address - State:OH
Practice Address - Zip Code:43442-9724
Practice Address - Country:US
Practice Address - Phone:419-205-3659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH006355225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0940576Medicaid