Provider Demographics
NPI:1679506190
Name:HIRACHETA, JERRY J (OT)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:J
Last Name:HIRACHETA
Suffix:
Gender:M
Credentials:OT
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Mailing Address - Street 1:5219 CITY BANK PKWY
Mailing Address - Street 2:STE 35
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3544
Mailing Address - Country:US
Mailing Address - Phone:806-785-7676
Mailing Address - Fax:806-785-7685
Practice Address - Street 1:2404 YONKERS ST
Practice Address - Street 2:STE 11
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-1820
Practice Address - Country:US
Practice Address - Phone:806-296-2444
Practice Address - Fax:806-296-9709
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX109569225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist