Provider Demographics
NPI:1215924493
Name:ROBERTSON, CHERYL LINDA (OTR)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:LINDA
Last Name:ROBERTSON
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 1:140 CORDOBA CENTER DR
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71909-4020
Mailing Address - Country:US
Mailing Address - Phone:501-922-1686
Mailing Address - Fax:501-922-9735
Practice Address - Street 1:140 CORDOBA CENTER DR
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71909-4020
Practice Address - Country:US
Practice Address - Phone:501-922-1686
Practice Address - Fax:501-922-9735
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5Y4312083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5Y431Medicare ID - Type Unspecified