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General NPI Number Information
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NPI Number | 1164638763
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Entity Type | Individual
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Provider Name | IDA D CIPRIANO OTR
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Gender | Female
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3304 MERRIMACK LN
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City | FLOWER MOUND
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State | TX
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Zip | 75022-4461
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Country | US
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Telephone | 972-795-4883
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Fax |
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Provider Business Mailing Address
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Address Line | 3304 MERRIMACK LN
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City | FLOWER MOUND
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State | TX
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Zip | 75022-4461
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Country | US
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Telephone | 972-795-4883
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 102243
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License Number State | TX
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