Provider Demographics
NPI:1467513689
Name:MERCADO, CHERYL ANNE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ANNE
Last Name:MERCADO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:CHERYL
Other - Middle Name:ANNE
Other - Last Name:SAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2118 N CAMPBELL AVE
Mailing Address - Street 2:#2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4102
Mailing Address - Country:US
Mailing Address - Phone:773-551-7581
Mailing Address - Fax:773-486-7581
Practice Address - Street 1:2118 N CAMPBELL AVE
Practice Address - Street 2:#2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4102
Practice Address - Country:US
Practice Address - Phone:773-551-7581
Practice Address - Fax:773-486-7581
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics