Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 107963 | TX |
NPI | 1053648840 |
---|---|
Provider Name | Tara R Cecil |
First Address | Hutto, TX 78634-5084 |
Second Address | Round Rock, TX 78664-3289 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2009 |
Last Update Date | 19/09/2012 |