Individual
MRS. CHERYL M KINGSBURY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, OTR/L
Contact information
Practice address
1791 MESQUITE AVE, LAKE HAVASU CITY, AZ 86403-5648
(928) 855-4248
(928) 855-7452
Mailing address
25 RIVIERA BLVD, LAKE HAVASU CITY, AZ 86403-5694
(928) 505-5555
(928) 505-2877
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3342
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3342
ARIZONA OT LICENSE
AZ
05
—
910770
—
AZ
Enumeration date
09/27/2010
Last updated
06/10/2014
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