MEDICARE: MRS. STEPHANIE WILLIAMS CAILLABET

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	32026651391	TX

General Provider Information

NPI Number	:	1063637189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE WILLIAMS CAILLABET

Provider Business Mailing Address
First Line	:	1032 TOM SAWYER
Second Line	:
City	:	DRIPPING SPRINGS
State	:	TX
Zip	:	78620-4466
Country	:	US
Telephone Number	:	512-626-0879
Fax Number	:	512-858-0759

Provider Business Practice Location Address
First Line	:	1032 TOM SAWYER
Second Line	:
City	:	DRIPPING SPRINGS
State	:	TX
Zip	:	78620-4466
Country	:	US
Telephone Number	:	512-626-0879
Fax Number	:	512-858-0759

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	07/08/2007

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