Provider Demographics
NPI:1184602161
Name:SMITH, CHERYL LYNN (MSPT, OT)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSPT, OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10150 LANTERN RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9706
Mailing Address - Country:US
Mailing Address - Phone:317-806-7803
Mailing Address - Fax:317-806-7804
Practice Address - Street 1:10150 LANTERN RD
Practice Address - Street 2:SUITE 225
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9706
Practice Address - Country:US
Practice Address - Phone:317-806-7803
Practice Address - Fax:317-806-7804
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001847A225100000X
IN31000807A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP43885Medicare UPIN
IN185500BMedicare ID - Type Unspecified