Provider Demographics
NPI:1356629760
Name:CHERRY, AMY CRISTEN (OTR)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:CRISTEN
Last Name:CHERRY
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 1:950 OLD PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-5449
Mailing Address - Country:US
Mailing Address - Phone:936-328-8148
Mailing Address - Fax:936-327-2491
Practice Address - Street 1:440 HIGHWAY 59 LOOP S
Practice Address - Street 2:SUITE 104
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-9096
Practice Address - Country:US
Practice Address - Phone:936-328-8148
Practice Address - Fax:936-327-2491
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109182225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX005728303Medicaid
TX005728302Medicaid