Provider Demographics
NPI:1376714923
Name:JESSIE, CHERYL C (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:C
Last Name:JESSIE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 N. BENNINGTON RD.
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03442
Mailing Address - Country:US
Mailing Address - Phone:603-588-2219
Mailing Address - Fax:
Practice Address - Street 1:556 N BENNINGTON RD
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:NH
Practice Address - Zip Code:03442-4505
Practice Address - Country:US
Practice Address - Phone:603-588-2219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0682225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist