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General NPI Number Information
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NPI Number | 1730468794
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Entity Type | Individual
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Provider Name | YESSICA KARINA SEPULVEDA OTR
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Gender | Female
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Dates
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Enumeration Date | 08/09/2011
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Last Update Date | 01/04/2021
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Provider Practice Location Address
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Address Line | 2200 S LAKELINE BLVD
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City | CEDAR PARK
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State | TX
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Zip | 78613-4567
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Country | US
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Telephone | 512-813-9299
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Fax |
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Provider Business Mailing Address
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Address Line | 7613 URAY DR
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City | AUSTIN
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State | TX
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Zip | 78724-3353
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Country | US
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Telephone | 956-246-0373
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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 | 114167
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License Number State | TX
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