Provider Demographics
NPI:1356526669
Name:ERVIN, CHERYL SUE (OTR)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:SUE
Last Name:ERVIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 RYELAND CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1210
Mailing Address - Country:US
Mailing Address - Phone:970-217-6960
Mailing Address - Fax:
Practice Address - Street 1:2307 RYELAND CT
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1210
Practice Address - Country:US
Practice Address - Phone:970-217-6960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8718225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist