Healthcare Provider Details

I. General information

NPI: 1508056870
Provider Name (Legal Business Name): VICTORIA LYNNE ALDEEN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICKI LYNNE TYNER OTR

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 EL SALIDO PKWY
CEDAR PARK TX
78613-5640
US

IV. Provider business mailing address

3405 EL SALIDO PARKWAY
CEDAR PARK TX
78613
US

V. Phone/Fax

Practice location:
  • Phone: 512-886-3374
  • Fax: 512-549-4822
Mailing address:
  • Phone: 512-886-3374
  • Fax: 512-549-4822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number103542
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: