Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 108406 | TX |
NPI | 1427684133 |
---|---|
Provider Name | Tanya Marie Escobar |
First Address | Austin, TX 78748-2385 |
Second Address | Austin, TX 78751-4223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2020 |
Last Update Date | 14/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1014627 | NBCOT (01) | MD |
108406 | TEXAS BOARD OF OCCUPATIONAL THERAPY EXAMINERS (01) | TX |