Provider Demographics
NPI:1750128112
Name:WOOD, CHEYENNE (OTR, OTD)
Entity type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:OTR, OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 ROCKBROOK DR APT 1138
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3822
Mailing Address - Country:US
Mailing Address - Phone:940-205-7653
Mailing Address - Fax:
Practice Address - Street 1:1301 JUSTIN RD STE 206
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-2150
Practice Address - Country:US
Practice Address - Phone:972-317-7775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124687225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics