Provider Demographics
NPI:1366727562
Name:MOCK, TERRY L
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:MOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E RIDGE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1536
Mailing Address - Country:US
Mailing Address - Phone:956-686-2150
Mailing Address - Fax:866-287-3592
Practice Address - Street 1:1400 E RIDGE RD STE 1
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1536
Practice Address - Country:US
Practice Address - Phone:956-686-2150
Practice Address - Fax:866-287-3592
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211321224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant