Provider Demographics
NPI:1265841357
Name:MASON-BAYLOR, ANQUINETTA MONIQUE (COTA/L)
Entity Type:Individual
Prefix:
First Name:ANQUINETTA
Middle Name:MONIQUE
Last Name:MASON-BAYLOR
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
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Mailing Address - Street 1:305 NE LOOP 820 BUSSINESS TOWER 1
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053
Mailing Address - Country:US
Mailing Address - Phone:817-292-8787
Mailing Address - Fax:817-789-6849
Practice Address - Street 1:87 I-10 NORTH
Practice Address - Street 2:SUITE 225
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707
Practice Address - Country:US
Practice Address - Phone:409-835-0151
Practice Address - Fax:409-835-0228
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX212648224Z00000X
LA200438224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant