Provider Demographics
NPI:1649311887
Name:WIDEN, CHERYL HUNTLEY (OTR)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:HUNTLEY
Last Name:WIDEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:CHERYL
Other - Middle Name:ANN
Other - Last Name:WIDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:1212 103RD ST
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77554-9591
Mailing Address - Country:US
Mailing Address - Phone:281-480-5648
Mailing Address - Fax:281-480-5691
Practice Address - Street 1:17045 EL CAMINO REAL
Practice Address - Street 2:SUITE 106
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2649
Practice Address - Country:US
Practice Address - Phone:281-480-5648
Practice Address - Fax:281-480-5691
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104110225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist