Provider Demographics
NPI:1649468331
Name:BUSHART, CHERYL JAYNE
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:JAYNE
Last Name:BUSHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:JAYNE
Other - Last Name:RECIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5969 NELDA ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-4059
Mailing Address - Country:US
Mailing Address - Phone:805-581-5440
Mailing Address - Fax:
Practice Address - Street 1:5969 NELDA ST
Practice Address - Street 2:UNIT 1
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-4059
Practice Address - Country:US
Practice Address - Phone:805-581-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA908224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant