Provider Demographics
NPI:1245389857
Name:WICKREMA, CHERYL (OTR)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:
Last Name:WICKREMA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3912 BRETT LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1204
Mailing Address - Country:US
Mailing Address - Phone:847-832-1383
Mailing Address - Fax:
Practice Address - Street 1:241 GOLF MILL CTR
Practice Address - Street 2:SUITE 201
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1224
Practice Address - Country:US
Practice Address - Phone:847-699-9757
Practice Address - Fax:847-699-5037
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics