Provider Demographics
NPI:1275124612
Name:VILLEMAIRE, SIERRA ROSE
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:ROSE
Last Name:VILLEMAIRE
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 1:350 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-4420
Mailing Address - Country:US
Mailing Address - Phone:802-373-3570
Mailing Address - Fax:
Practice Address - Street 1:1000 W COURT ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5978
Practice Address - Country:US
Practice Address - Phone:830-372-6319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT79582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer