Provider Demographics
NPI:1427783968
Name:YERKES, GRACE ELLEN (OTR/L)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ELLEN
Last Name:YERKES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 GUADALUPE ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-4224
Mailing Address - Country:US
Mailing Address - Phone:737-204-0089
Mailing Address - Fax:737-204-0098
Practice Address - Street 1:4225 GUADALUPE ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-4224
Practice Address - Country:US
Practice Address - Phone:737-204-0089
Practice Address - Fax:737-204-0098
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122833225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122833OtherLICENSE