Provider Demographics
NPI:1184724031
Name:GARRANT, CHERYL J (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:J
Last Name:GARRANT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:CHERYL
Other - Middle Name:L
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:100 KAYADEROSSERAS DR
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-2528
Mailing Address - Country:US
Mailing Address - Phone:518-885-1912
Mailing Address - Fax:
Practice Address - Street 1:100 KAYADEROSSERAS DR
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-2528
Practice Address - Country:US
Practice Address - Phone:518-885-1912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010040-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00752456Medicaid