Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 116167 | TX |
NPI | 1003909284 |
---|---|
Provider Name | Sheryl Bask |
First Address | Gainesville, FL 32605-2648 |
Second Address | Austin, TX 78727-7167 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 14/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
703252100A | (05) | GA |