Provider Demographics
NPI:1700299278
Name:WATSON, CHERYL L
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:L
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:L
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:476 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:STRUTHERS
Mailing Address - State:OH
Mailing Address - Zip Code:44471-1014
Mailing Address - Country:US
Mailing Address - Phone:330-509-4018
Mailing Address - Fax:
Practice Address - Street 1:476 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:STRUTHERS
Practice Address - State:OH
Practice Address - Zip Code:44471-1014
Practice Address - Country:US
Practice Address - Phone:330-755-4018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0024565172V00000X, 251E00000X, 405300000X, 3747P1801X, 3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No172V00000XOther Service ProvidersCommunity Health Worker
No251E00000XAgenciesHome Health
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0024565Medicaid
OH0278775Medicaid