Provider Demographics
NPI:1174864631
Name:FAIL, MARY DAWN (CTRS)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:DAWN
Last Name:FAIL
Suffix:
Gender:F
Credentials:CTRS
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Mailing Address - Street 1:1447 BUNKER ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-4868
Mailing Address - Country:US
Mailing Address - Phone:254-627-9777
Mailing Address - Fax:
Practice Address - Street 1:7400 MERTON MINTER ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4404
Practice Address - Country:US
Practice Address - Phone:210-617-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-08
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX60478225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist