Provider Demographics
NPI:1568589828
Name:FOSTER, CHERYL (COTA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:FOSTER
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 1:1422 OLD HIGHWAY 35 N
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429-9021
Mailing Address - Country:US
Mailing Address - Phone:601-441-9609
Mailing Address - Fax:
Practice Address - Street 1:26 SPINET RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-3512
Practice Address - Country:US
Practice Address - Phone:302-292-1127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSTA2508224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant