Provider Demographics
NPI:1043304868
Name:BASMAYOR, SHEILA
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:BASMAYOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:
Other - Last Name:MASCARINAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1930 E 20TH ST APT C7
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1022
Mailing Address - Country:US
Mailing Address - Phone:417-396-6458
Mailing Address - Fax:
Practice Address - Street 1:100 E VINE ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-3734
Practice Address - Country:US
Practice Address - Phone:615-890-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006023842225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist