=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164119665
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RHONDA YARDAS OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2023
-----------------------------------------------------
Last Update Date | 04/24/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14101 W HWY 290 STE 700A
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78737-9346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-894-5005
-----------------------------------------------------
Fax | 512-597-3212
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 561 MANCHESTER LN
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78737-4543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-894-5005
-----------------------------------------------------
Fax | 512-597-3212
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | 110734
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------