Provider Demographics
NPI:1295103190
Name:YEBRA, SUSAN LYNN (OTR)
Entity type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:LYNN
Last Name:YEBRA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 BESSEMER DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5930
Mailing Address - Country:US
Mailing Address - Phone:915-319-0671
Mailing Address - Fax:
Practice Address - Street 1:1445 BESSEMER DR
Practice Address - Street 2:SUITE C
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5930
Practice Address - Country:US
Practice Address - Phone:915-319-0671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116810225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist