Provider Demographics
NPI:1225229222
Name:MODEL, CHERYL B (OTR/L)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:B
Last Name:MODEL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MODEL
Other - Middle Name:
Other - Last Name:WELLNESS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3156 ROYAL PALM AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3938
Mailing Address - Country:US
Mailing Address - Phone:305-542-3344
Mailing Address - Fax:305-673-0707
Practice Address - Street 1:3156 ROYAL PALM AVE
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3938
Practice Address - Country:US
Practice Address - Phone:305-542-3344
Practice Address - Fax:305-673-0707
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0418174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist