Healthcare Provider Details

I. General information

NPI: 1891085502
Provider Name (Legal Business Name): CHERYL WATKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 06/14/2025
Certification Date: 06/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18604 THORNBERRY LN
OLNEY MD
20832-1819
US

IV. Provider business mailing address

18604 THORNBERRY LN
OLNEY MD
20832-1819
US

V. Phone/Fax

Practice location:
  • Phone: 301-717-5929
  • Fax: 240-252-2108
Mailing address:
  • Phone: 301-717-5929
  • Fax: 240-252-2108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number05729
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number05729
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: