MEDICARE: CHERYL PICKETT

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	1744P3200X	Prosthetics Case Management
2	224P00000X	Prosthetist

General Provider Information

NPI Number	:	1861197352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL PICKETT

Provider Business Mailing Address
First Line	:	PO BOX 604
Second Line	:
City	:	TEMPLE
State	:	GA
Zip	:	30179-0604
Country	:	US
Telephone Number	:	910-977-6112
Fax Number	:

Provider Business Practice Location Address
First Line	:	4211 N SHORE DR STE E
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3273
Country	:	US
Telephone Number	:	561-845-2616
Fax Number	:

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

Provider Enumeration Date	:	04/03/2023
Last Update Date	:	04/03/2023

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Directions to “ CHERYL PICKETT ” Practice Location

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