MEDICARE: MS. CHERENE SUSAN COMICK MED, PCET

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist	44269	VA
2	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1447089834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHERENE SUSAN COMICK MED, PCET

Provider Business Mailing Address
First Line	:	108 HAY ST STE 212
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28301-5686
Country	:	US
Telephone Number	:	862-754-5296
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 HAY ST STE 212
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28301-5686
Country	:	US
Telephone Number	:	862-754-5296
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2024
Last Update Date	:	05/05/2025

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