Healthcare Provider Details

I. General information

NPI: 1922641497
Provider Name (Legal Business Name): MRS. LAURA A SYKORA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 S JACKSON ST
SAN ANGELO TX
76904-5129
US

IV. Provider business mailing address

4601 HARTFORD ST
ABILENE TX
79605-4603
US

V. Phone/Fax

Practice location:
  • Phone: 325-223-6300
  • Fax: 325-793-3587
Mailing address:
  • Phone: 325-793-3400
  • Fax: 325-793-3587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number120369
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: