MEDICARE: ERICA FAZ LABASBAS OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	109210	TX

General Provider Information

NPI Number	:	1164409934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA FAZ LABASBAS OTR

Provider Business Mailing Address
First Line	:	5403 N MCCOLL RD
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-2206
Country	:	US
Telephone Number	:	956-661-0777
Fax Number	:	956-661-0774

Provider Business Practice Location Address
First Line	:	5403 N MCCOLL RD
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-2206
Country	:	US
Telephone Number	:	956-661-0777
Fax Number	:	956-661-0774

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	07/08/2007

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