Provider Demographics
NPI:1881045581
Name:COUSINS, CHERYL LYNN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:LYNN
Last Name:COUSINS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 POOR FARM RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04617-3439
Mailing Address - Country:US
Mailing Address - Phone:207-949-3627
Mailing Address - Fax:
Practice Address - Street 1:82 SOUTH ST
Practice Address - Street 2:
Practice Address - City:BLUE HILL
Practice Address - State:ME
Practice Address - Zip Code:04614-6119
Practice Address - Country:US
Practice Address - Phone:207-949-3627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT5252225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist