Healthcare Provider Details

I. General information

NPI: 1356371181
Provider Name (Legal Business Name): CHERYL JOY ROKOS CMOF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 NORTH FIRST STREET ROOM 1034
SPRINGFIELD IL
62702
US

IV. Provider business mailing address

1809 SEVEN PINES RD APT. 9
SPRINGFIELD IL
62704-5716
US

V. Phone/Fax

Practice location:
  • Phone: 217-528-7541
  • Fax: 217-522-3118
Mailing address:
  • Phone: 217-726-1918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: