Healthcare Provider Details

I. General information

NPI: 1427575596
Provider Name (Legal Business Name): JACLYN MICHELLE VIRANT OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 CABALLO RANCH BLVD STE 7D
CEDAR PARK TX
78641-4637
US

IV. Provider business mailing address

2901 CABALLO RANCH BLVD STE 7D
CEDAR PARK TX
78641-4637
US

V. Phone/Fax

Practice location:
  • Phone: 512-222-6828
  • Fax: 866-428-6864
Mailing address:
  • Phone: 512-222-6828
  • Fax: 866-428-6864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number117027
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: