=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881839793
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CECILY GREEN YELEK CMT, LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2008
-----------------------------------------------------
Last Update Date | 12/05/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 N 3RD ST. #3
-----------------------------------------------------
City | STRATFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-290-3655
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7199 COUNTY ROAD P
-----------------------------------------------------
City | SUNRAY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79086-7120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-753-4400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MT107769
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------