Basic Information
Provider Information
NPI: 1568508828
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LLOYD
FirstName: CHERISH
MiddleName: E
NamePrefix: MRS.
NameSuffix:  
Credential: OTRL
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 13742 FRONTIER ST
Address2:  
City: RIVERTON
State: UT
PostalCode: 840655885
CountryCode: US
TelephoneNumber: 8012547253
FaxNumber:  
Practice Location
Address1: 1952 FORT UNION BLVD
Address2: SUITE 100
City: SALT LAKE CITY
State: UT
PostalCode: 841216877
CountryCode: US
TelephoneNumber: 8019423311
FaxNumber: 8019425955
Other Information
ProviderEnumerationDate: 01/30/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X52253954201UTY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


Home