Provider Demographics
NPI:1164409934
Name:LABASBAS, ERICA FAZ (OTR)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:FAZ
Last Name:LABASBAS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5403 N MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2206
Mailing Address - Country:US
Mailing Address - Phone:956-661-0777
Mailing Address - Fax:956-661-0774
Practice Address - Street 1:5403 N MCCOLL RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2206
Practice Address - Country:US
Practice Address - Phone:956-661-0777
Practice Address - Fax:956-661-0774
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109210225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F1855Medicare ID - Type UnspecifiedMCR B GROUP NUMBER