Healthcare Provider Details

I. General information

NPI: 1619760287
Provider Name (Legal Business Name): REBECCA CHEATHAM ATP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 GALLAGHER DR
SHERMAN TX
75090-1750
US

IV. Provider business mailing address

3419 CEDAR LN
MELISSA TX
75454-3304
US

V. Phone/Fax

Practice location:
  • Phone: 903-747-1644
  • Fax: 903-408-6441
Mailing address:
  • Phone: 214-725-6384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number99996
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225CA2400X
TaxonomyAssistive Technology Practitioner Rehabilitation Counselor
License Number99996
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: