Provider Demographics
NPI:1265739221
Name:MILLER, CHERYL MARTIN
Entity type:Individual
Prefix:MR
First Name:CHERYL
Middle Name:MARTIN
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CHERYL
Other - Middle Name:ANN
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7646 CHASECREEK DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-1882
Mailing Address - Country:US
Mailing Address - Phone:832-788-6181
Mailing Address - Fax:281-437-4725
Practice Address - Street 1:7646 CHASECREEK DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-1882
Practice Address - Country:US
Practice Address - Phone:832-788-6181
Practice Address - Fax:281-437-4725
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-27
Last Update Date:2011-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency