Basic Information
Provider Information | |||||||||
NPI: | 1063682441 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MCKAY | ||||||||
FirstName: | SHERYL | ||||||||
MiddleName: | LEONA | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | C.O.T.A. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 165 OAK RUN | ||||||||
Address2: |   | ||||||||
City: | WHITNEY | ||||||||
State: | TX | ||||||||
PostalCode: | 766924552 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4697656609 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1108 W KILPATRICK | ||||||||
Address2: | CLEBURE REHABILITATION & HEALTH CARE CENTER | ||||||||
City: | CLEBURNE | ||||||||
State: | TX | ||||||||
PostalCode: | 76033 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8176453931 | ||||||||
FaxNumber: | 8176451879 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/03/2008 | ||||||||
LastUpdateDate: | 03/03/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 207839 | TX | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |   |
No ID Information.