Provider Demographics
NPI:1437204757
Name:CHENEY, DESIREE JEAN (OTR)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:JEAN
Last Name:CHENEY
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 1:1009 BURGUNDY LN
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4159
Mailing Address - Country:US
Mailing Address - Phone:636-256-0911
Mailing Address - Fax:636-256-0911
Practice Address - Street 1:1009 BURGUNDY LN
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-4159
Practice Address - Country:US
Practice Address - Phone:636-256-0911
Practice Address - Fax:636-256-0911
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004727225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics