Provider Demographics
NPI:1265914865
Name:MCMILLAN, CHERYL KAY (COTA)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:KAY
Last Name:MCMILLAN
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 1:1000 FM 3220
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:TX
Mailing Address - Zip Code:76634-1034
Mailing Address - Country:US
Mailing Address - Phone:254-675-2828
Mailing Address - Fax:254-675-2929
Practice Address - Street 1:1000 FM 3220
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:TX
Practice Address - Zip Code:76634-1034
Practice Address - Country:US
Practice Address - Phone:254-675-2828
Practice Address - Fax:254-675-2929
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208685224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant