Provider Demographics
NPI:1619760287
Name:CHEATHAM, REBECCA (ATP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:CHEATHAM
Suffix:
Gender:F
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3419 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:MELISSA
Mailing Address - State:TX
Mailing Address - Zip Code:75454-3304
Mailing Address - Country:US
Mailing Address - Phone:214-725-6384
Mailing Address - Fax:
Practice Address - Street 1:803 GALLAGHER DR
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-1750
Practice Address - Country:US
Practice Address - Phone:903-747-1644
Practice Address - Fax:903-408-6441
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99996225CA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Practitioner