Provider Demographics
NPI:1104508167
Name:DEARY, SIERRA LOUISE (MAT, ATC, LAT)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:LOUISE
Last Name:DEARY
Suffix:
Gender:F
Credentials:MAT, ATC, LAT
Other - Prefix:
Other - First Name:SIERRA
Other - Middle Name:LOUISE
Other - Last Name:HOLCOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAT, ATC, LAT
Mailing Address - Street 1:242 WESTLAKE
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-4081
Mailing Address - Country:US
Mailing Address - Phone:903-875-4009
Mailing Address - Fax:
Practice Address - Street 1:3300 POTEET DR
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4760
Practice Address - Country:US
Practice Address - Phone:903-875-4009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT25212255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer