Provider Demographics
NPI:1497375950
Name:CHERRY, TONISHA RENEE (OTR/L)
Entity Type:Individual
Prefix:
First Name:TONISHA
Middle Name:RENEE
Last Name:CHERRY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4157 PINE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-6100
Mailing Address - Country:US
Mailing Address - Phone:404-468-4658
Mailing Address - Fax:
Practice Address - Street 1:4150 DEPUTY BILL CANTRELL MEMORIAL ROAD
Practice Address - Street 2:SUITE T200
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-3002
Practice Address - Country:US
Practice Address - Phone:470-839-3041
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007720225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist