Provider Demographics
NPI:1528891686
Name:BIRKES, SKYLARE FAY (COTA/L)
Entity type:Individual
Prefix:
First Name:SKYLARE
Middle Name:FAY
Last Name:BIRKES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 MCCULLOUGH CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-6606
Mailing Address - Country:US
Mailing Address - Phone:731-334-9048
Mailing Address - Fax:
Practice Address - Street 1:3504 MCCULLOUGH CHAPEL RD
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-6606
Practice Address - Country:US
Practice Address - Phone:731-334-9048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4169224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant