Individual
BETHANY TACKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MOT, OTR/L
Contact information
Practice address
3000 JOE DIMAGGIO BLVD STE 56, ROUND ROCK, TX 78665-3996
(512) 218-6955
Mailing address
10430 MORADO CIR APT 2012, AUSTIN, TX 78759-5669
(785) 302-0658
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
122054
TX
Other
Enumeration date
10/21/2021
Last updated
10/21/2021
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