Provider Demographics
NPI:1710517776
Name:RYDER, SARAH ANN
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN
Last Name:RYDER
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 1:383 COUNTY ROAD 2700
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75973-3041
Mailing Address - Country:US
Mailing Address - Phone:936-488-2919
Mailing Address - Fax:
Practice Address - Street 1:383 COUNTY ROAD 2700
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TX
Practice Address - Zip Code:75973-3041
Practice Address - Country:US
Practice Address - Phone:936-488-2919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-18
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120468225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120468OtherTEXAS BOARD OF OCCUPATIONAL THERAPY EXAMINERS