Provider Demographics
NPI:1235126418
Name:STEVENSON, CHERYL (OTR/L)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:
Other - Last Name:BERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:424 FINNIN RD
Mailing Address - Street 2:
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-6808
Mailing Address - Country:US
Mailing Address - Phone:724-335-3032
Mailing Address - Fax:
Practice Address - Street 1:2757 LEECHBURG RD
Practice Address - Street 2:
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068-3138
Practice Address - Country:US
Practice Address - Phone:724-337-6522
Practice Address - Fax:724-337-0630
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC000774L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA158184OtherTHREE RIVERS HEALTH PLAN
PA1011313690001Medicaid