Provider Demographics
NPI:1659971323
Name:RIDGWAY, CHEYENNE L (OTD, OTR)
Entity type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:L
Last Name:RIDGWAY
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:CHEYENNE
Other - Middle Name:L
Other - Last Name:KERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD, OTR
Mailing Address - Street 1:113 AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-2053
Mailing Address - Country:US
Mailing Address - Phone:317-513-1986
Mailing Address - Fax:
Practice Address - Street 1:113 AZALEA DR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-2053
Practice Address - Country:US
Practice Address - Phone:812-560-9138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist