Provider Demographics
NPI:1003165465
Name:ZUPAN, RAYCHAL NYCOLE (OTR)
Entity Type:Individual
Prefix:
First Name:RAYCHAL
Middle Name:NYCOLE
Last Name:ZUPAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 FRANKLIN BLVD
Mailing Address - Street 2:D
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751
Mailing Address - Country:US
Mailing Address - Phone:218-343-0429
Mailing Address - Fax:
Practice Address - Street 1:4607 MANCHACA RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1607
Practice Address - Country:US
Practice Address - Phone:512-916-1511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114894225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist