Provider Demographics
NPI:1295930733
Name:MAGENCE, CHERYL (OT)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:
Last Name:MAGENCE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8501 LAWNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2331
Mailing Address - Country:US
Mailing Address - Phone:847-679-6867
Mailing Address - Fax:
Practice Address - Street 1:8501 LAWNDALE AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-2331
Practice Address - Country:US
Practice Address - Phone:847-679-6867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist