Provider Demographics
NPI:1912012782
Name:SYPERT, RICKY D (OT)
Entity Type:Individual
Prefix:MR
First Name:RICKY
Middle Name:D
Last Name:SYPERT
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4642 N LOOP 289
Mailing Address - Street 2:SUITE 219
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416
Mailing Address - Country:US
Mailing Address - Phone:806-795-7762
Mailing Address - Fax:806-796-7168
Practice Address - Street 1:4642 N LOOP 289
Practice Address - Street 2:SUITE 219
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416
Practice Address - Country:US
Practice Address - Phone:806-795-7762
Practice Address - Fax:806-796-7168
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103802225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103802OtherLICENSE #