Provider Demographics
NPI:1972776805
Name:WATKINS, CHERYL A (0T)
Entity type:Individual
Prefix:MISS
First Name:CHERYL
Middle Name:A
Last Name:WATKINS
Suffix:
Gender:F
Credentials:0T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 BLACK WALNUT WAY
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-8101
Mailing Address - Country:US
Mailing Address - Phone:530-893-9255
Mailing Address - Fax:
Practice Address - Street 1:375 COHASSET RD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2211
Practice Address - Country:US
Practice Address - Phone:530-343-5595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 5076225X00000X
CAOT 5076314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility