Healthcare Provider Details

I. General information

NPI: 1184053258
Provider Name (Legal Business Name): RAYMOND YARBROUGH ATP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11110 METRIC BLVD STE A
AUSTIN TX
78758-4097
US

IV. Provider business mailing address

8217 SUMMER SIDE DR
AUSTIN TX
78759-8315
US

V. Phone/Fax

Practice location:
  • Phone: 512-663-7477
  • Fax:
Mailing address:
  • Phone: 512-845-8389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225CA2400X
TaxonomyAssistive Technology Practitioner Rehabilitation Counselor
License NumberATP 52501
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: