Provider Demographics
NPI:1376780353
Name:BLACKMON-THORNE, CHERYL ELIZABETH (COTA)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ELIZABETH
Last Name:BLACKMON-THORNE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PARK AVE APT 7K
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2138
Mailing Address - Country:US
Mailing Address - Phone:914-665-6080
Mailing Address - Fax:
Practice Address - Street 1:30 PARK AVE APT 7K
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2138
Practice Address - Country:US
Practice Address - Phone:914-665-6080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-1398224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant