1063682441 NPI number — MRS. SHERYL LEONA MCKAY C.O.T.A.

Table of content: MRS. SHERYL LEONA MCKAY C.O.T.A. (NPI 1063682441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063682441 NPI number — MRS. SHERYL LEONA MCKAY C.O.T.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCKAY
Provider First Name:
SHERYL
Provider Middle Name:
LEONA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
C.O.T.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063682441
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
165 OAK RUN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITNEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76692-4552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-765-6609
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1108 W KILPATRICK
Provider Second Line Business Practice Location Address:
CLEBURE REHABILITATION & HEALTH CARE CENTER
Provider Business Practice Location Address City Name:
CLEBURNE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-645-3931
Provider Business Practice Location Address Fax Number:
817-645-1879
Provider Enumeration Date:
03/03/2008

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:  207839 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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