Basic Information
| Provider Information | |||||||||
| NPI: | 1679064240 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOUCY | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | OTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1205 S 8TH ST # 353 | ||||||||
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| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767061443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2542270106 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1700 WOODGATE DR # 8600 | ||||||||
| Address2: | |||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767128600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2546665454 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2018 | ||||||||
| LastUpdateDate: | 02/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 117252 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.