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NPI Code Detail

MEDICARE: TIARA UNDERWOOD RBT

MEDICARE: TIARA UNDERWOOD RBT
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
1106S00000XBehavior TechnicianRBT-25-477719TX

General Provider Information

NPI Number : 1205782208
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIARA UNDERWOOD RBT
Provider Business Mailing Address
First Line : PO BOX 151716
Second Line :
City : AUSTIN
State : TX
Zip : 78715-1716
Country : US
Telephone Number : 512-898-9044
Fax Number : 512-857-1423
Provider Business Practice Location Address
First Line : 4407 PACK SADDLE PASS
Second Line :
City : AUSTIN
State : TX
Zip : 78745-1623
Country : US
Telephone Number : 512-898-9044
Fax Number : 512-857-1423
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2026
Last Update Date : 03/10/2026

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Directions to “ TIARA UNDERWOOD RBT” Practice Location

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