Provider Demographics
NPI:1821409897
Name:VERSIE, MONICA ROSE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:ROSE
Last Name:VERSIE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:MONICA
Other - Middle Name:ROSE
Other - Last Name:DOMINGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:2207 SPARROW RD
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-5830
Mailing Address - Country:US
Mailing Address - Phone:915-861-5788
Mailing Address - Fax:
Practice Address - Street 1:2207 SPARROW RD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-5830
Practice Address - Country:US
Practice Address - Phone:915-861-5788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111466225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist