Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 120078 | TX |
NPI | 1487209243 |
---|---|
Provider Name | Bayley Tarantolo |
First Address | Austin, TX 78754-5855 |
Second Address | Round Rock, TX 78665-9323 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2019 |
Last Update Date | 07/08/2019 |