Basic Information
| Provider Information | |||||||||
| NPI: | 1942238449 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PETERSILGE | ||||||||
| FirstName: | CHERYL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1675 E MAIN ST | ||||||||
| Address2: | P. O. BOX 328 | ||||||||
| City: | KENT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442405818 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1930 STATE ROUTE 59 | ||||||||
| Address2: | SUITE 3950 | ||||||||
| City: | KENT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442404112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306773632 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 05/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 35065307P | OH | Y | Other Service Providers | Specialist |
No ID Information.