Provider Demographics
NPI:1730561176
Name:CHEATHAM, ELAINE C (BACHELOR OF SCIENCE)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:C
Last Name:CHEATHAM
Suffix:
Gender:F
Credentials:BACHELOR OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 SW 48TH STREET
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73119
Mailing Address - Country:US
Mailing Address - Phone:405-549-4181
Mailing Address - Fax:
Practice Address - Street 1:2124 SW 48TH STREET
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119
Practice Address - Country:US
Practice Address - Phone:405-549-4181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator