Basic Information
| Provider Information | |||||||||
| NPI: | 1740482199 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GATES | ||||||||
| FirstName: | CHERDON | ||||||||
| MiddleName: | CATHERINE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | A.T., C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 512 FOXTRAIL CIR W | ||||||||
| Address2: | |||||||||
| City: | WESTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430812855 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148916653 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4605 SAWMILL RD | ||||||||
| Address2: | |||||||||
| City: | UPPER ARLINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432202246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148278700 | ||||||||
| FaxNumber: | 6148277106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | AT.001147 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.