Provider Demographics
NPI:1356866099
Name:CHEATHAM, REGINA MARIE
Entity Type:Individual
Prefix:MISS
First Name:REGINA
Middle Name:MARIE
Last Name:CHEATHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 BRITTAIN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-1879
Mailing Address - Country:US
Mailing Address - Phone:330-472-1901
Mailing Address - Fax:
Practice Address - Street 1:1717 BRITTAIN RD STE 103
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-1879
Practice Address - Country:US
Practice Address - Phone:330-472-1901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02091933747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider