MEDICARE: RUBIE YOLANDA PENIGAR-TAYLOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	101198	TX

General Provider Information

NPI Number	:	1346455656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUBIE YOLANDA PENIGAR-TAYLOR

Provider Business Mailing Address
First Line	:	PO BOX 601151
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75360-1151
Country	:	US
Telephone Number	:	817-467-9951
Fax Number	:	817-468-9733

Provider Business Practice Location Address
First Line	:	5201 S COOPER ST
Second Line	:	#111
City	:	ARLINGTON
State	:	TX
Zip	:	76017-5933
Country	:	US
Telephone Number	:	817-467-9951
Fax Number	:	817-468-9733

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	07/08/2007

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