Provider Demographics
NPI:1013379965
Name:SKERRETT, TIMOTHY RYAN (OTR / L)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:RYAN
Last Name:SKERRETT
Suffix:
Gender:M
Credentials:OTR / L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 DISCOVERY BLVD STE 211
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2417
Mailing Address - Country:US
Mailing Address - Phone:512-259-4263
Mailing Address - Fax:
Practice Address - Street 1:715 DISCOVERY BLVD STE 211
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2417
Practice Address - Country:US
Practice Address - Phone:512-259-4263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-21
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117437225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist