=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184034076
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SKY REHABILITATION SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2014
-----------------------------------------------------
Last Update Date | 05/01/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 439 CLIFFORD ST
-----------------------------------------------------
City | CORPUS CHRISTI
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78404-1925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-876-3264
-----------------------------------------------------
Fax | 713-929-3621
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 439 CLIFFORD ST
-----------------------------------------------------
City | CORPUS CHRISTI
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78404-1925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-876-3264
-----------------------------------------------------
Fax | 713-929-3621
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH LANGUAGE PATHALOGIST
-----------------------------------------------------
Name | ANGELA MARIA GALLEGOS
-----------------------------------------------------
Credential | SLP
-----------------------------------------------------
Telephone | 713-955-6087
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------