Provider Demographics
NPI:1396807608
Name:MUSKRAT, TERA DEVON (MS)
Entity type:Individual
Prefix:MRS
First Name:TERA
Middle Name:DEVON
Last Name:MUSKRAT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 508
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-0508
Mailing Address - Country:US
Mailing Address - Phone:505-737-6168
Mailing Address - Fax:
Practice Address - Street 1:200 SANDERS LN
Practice Address - Street 2:
Practice Address - City:RANCHOS DE TAOS
Practice Address - State:NM
Practice Address - Zip Code:87557-7809
Practice Address - Country:US
Practice Address - Phone:505-737-6150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3863235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM19322208Medicaid