=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184964611
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHERYL A FORD OT/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2013
-----------------------------------------------------
Last Update Date | 02/20/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 850 NELLIE ST
-----------------------------------------------------
City | GREENFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45123-1567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-981-2165
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 183 ANDERSON RD
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45177-8553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-816-2468
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 001599
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------