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General NPI Number Information
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NPI Number | 1689792061
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Entity Type | Individual
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Provider Name | JENNIE ANN TANNER OT
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Gender | Female
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 200 BUTTERCUP CREEK BLVD STE. 122
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City | CEDAR PARK
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State | TX
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Zip | 78613-3708
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Country | US
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Telephone | 512-219-8890
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Fax | 512-258-0090
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Provider Business Mailing Address
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Address Line | 2602 SILVER SPUR LN
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City | LEANDER
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State | TX
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Zip | 78641-7885
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Country | US
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Telephone | 512-535-2349
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 112044
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License Number State | TX
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