Provider Demographics
NPI:1447731450
Name:MESHACK, RUBIA PARWYN
Entity type:Individual
Prefix:
First Name:RUBIA
Middle Name:PARWYN
Last Name:MESHACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5204 SAGE VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-2042
Mailing Address - Country:US
Mailing Address - Phone:979-402-1308
Mailing Address - Fax:
Practice Address - Street 1:5204 SAGE VALLEY CT
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-2042
Practice Address - Country:US
Practice Address - Phone:979-402-1308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106826225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist