1487794723 NPI number — MS. LINDA G. CHERAMIE LOTR

Table of content: MS. LINDA G. CHERAMIE LOTR (NPI 1487794723)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487794723 NPI number — MS. LINDA G. CHERAMIE LOTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHERAMIE
Provider First Name:
LINDA
Provider Middle Name:
G.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LOTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEACOCK
Provider Other First Name:
LINDA
Provider Other Middle Name:
G
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LOTR
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487794723
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
169 TEQUESTA DRIVE
Provider Second Line Business Mailing Address:
SUITE 11E
Provider Business Mailing Address City Name:
TEQUESTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-747-6243
Provider Business Mailing Address Fax Number:
561-747-6273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
169 TEQUESTA DRIVE
Provider Second Line Business Practice Location Address:
SUITE 11E
Provider Business Practice Location Address City Name:
TEQUESTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-747-6243
Provider Business Practice Location Address Fax Number:
561-747-6273
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT3947 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8917205 00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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