Provider Demographics
NPI:1336306976
Name:CHEATHAM, ROBIN RENEE (MS)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:RENEE
Last Name:CHEATHAM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:RENEE
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7908 N SAM HOUSTON PKWY W
Mailing Address - Street 2:STE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-3508
Mailing Address - Country:US
Mailing Address - Phone:281-897-0416
Mailing Address - Fax:281-890-8908
Practice Address - Street 1:561 MEDICAL CENTER BLVD
Practice Address - Street 2:STE A
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4239
Practice Address - Country:US
Practice Address - Phone:281-338-1423
Practice Address - Fax:281-316-2173
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51372231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L4850Medicare PIN