Provider Demographics
NPI:1376738849
Name:PRUETT, CHERYL L ((C)OTA/L)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:PRUETT
Suffix:
Gender:F
Credentials:(C)OTA/L
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:L
Other - Last Name:PRUETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1284
Mailing Address - Street 2:501 WEST HAVENS SUITE 103
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-7284
Mailing Address - Country:US
Mailing Address - Phone:605-995-6044
Mailing Address - Fax:605-995-6044
Practice Address - Street 1:501 W HAVENS AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-4334
Practice Address - Country:US
Practice Address - Phone:605-995-6044
Practice Address - Fax:605-995-6044
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD110A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant