Healthcare Provider Details

I. General information

NPI: 1588387914
Provider Name (Legal Business Name): SALLY YEUNG OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7217 TELECOM PKWY STE 200
GARLAND TX
75044-2205
US

IV. Provider business mailing address

413 GOLDEN MEADOW DR
DESOTO TX
75115-7531
US

V. Phone/Fax

Practice location:
  • Phone: 972-495-6986
  • Fax:
Mailing address:
  • Phone: 214-952-4868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number123050
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: