Provider Demographics
NPI:1861067399
Name:RUDD, CHERYL STIPE (LOT)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:STIPE
Last Name:RUDD
Suffix:
Gender:F
Credentials:LOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9021 PINE MOSS DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-6930
Mailing Address - Country:US
Mailing Address - Phone:225-931-8049
Mailing Address - Fax:
Practice Address - Street 1:221 TUNICA DR W
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-2603
Practice Address - Country:US
Practice Address - Phone:318-253-5982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ10642225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist