MEDICARE: MS. CHERE M SKINNER OTRL

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	225XP0200X	Pediatric Occupational Therapist	OTR1932	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578674933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHERE M SKINNER OTRL

Provider Business Mailing Address
First Line	:	499 E REDBUD LN
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-3959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5230 WILLOW CREEK DR
Second Line	:	SUITE 101
City	:	SPRINGDALE
State	:	AR
Zip	:	72762-0876
Country	:	US
Telephone Number	:	479-445-6800
Fax Number	:	479-445-6816

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	09/28/2011

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