Provider Demographics
NPI:1750618716
Name:GOODREAU, CHERYL A (OTR-L)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:GOODREAU
Suffix:
Gender:F
Credentials:OTR-L
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:A
Other - Last Name:WALEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR-L
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:23800 ORCHARD LAKE RD
Practice Address - Street 2:STE 101
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-2560
Practice Address - Country:US
Practice Address - Phone:248-474-5516
Practice Address - Fax:248-474-5519
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201001320174400000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist