Individual
BETH BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
5205 KINGS HWY, AUSTIN, TX 78745-2817
(512) 968-2112
Mailing address
5205 KINGS HWY, AUSTIN, TX 78745-2817
(512) 968-2112
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
115626
TX
Other
Enumeration date
12/08/2015
Last updated
12/08/2015
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