Provider Demographics
NPI:1902027550
Name:OTERMAT, CHERYL ANN (MACCCSLP)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:ANN
Last Name:OTERMAT
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 LYNDON FARM CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5002
Mailing Address - Country:US
Mailing Address - Phone:502-412-5847
Mailing Address - Fax:502-412-0407
Practice Address - Street 1:1650 LYNDON FARM CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-5002
Practice Address - Country:US
Practice Address - Phone:502-412-5847
Practice Address - Fax:502-412-0407
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002898A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist