Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 114894 | TX |
NPI | 1003165465 |
---|---|
Provider Name | Raychal Nycole Zupan |
First Address | Austin, TX 78751 |
Second Address | Austin, TX 78745-1607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2012 |
Last Update Date | 31/08/2012 |