Provider Demographics
NPI:1194206680
Name:SEMBERA, BRAILEY MICHELLE
Entity Type:Individual
Prefix:
First Name:BRAILEY
Middle Name:MICHELLE
Last Name:SEMBERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 S REAGAN ST
Mailing Address - Street 2:
Mailing Address - City:WEST
Mailing Address - State:TX
Mailing Address - Zip Code:76691-1749
Mailing Address - Country:US
Mailing Address - Phone:254-230-7903
Mailing Address - Fax:
Practice Address - Street 1:300 W STATE HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-4041
Practice Address - Country:US
Practice Address - Phone:254-761-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214434224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant