Healthcare Provider Details

I. General information

NPI: 1285051292
Provider Name (Legal Business Name): ERICA SCARBROUGH OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W LOOP 340
WACO TX
76712-6840
US

IV. Provider business mailing address

601 W LOOP 340
WACO TX
76712-6840
US

V. Phone/Fax

Practice location:
  • Phone: 254-399-8255
  • Fax: 254-235-3408
Mailing address:
  • Phone: 254-399-8255
  • Fax: 254-235-3408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number115983
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: