Provider Demographics
NPI:1053648840
Name:CECIL, TARA R (OTR)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:R
Last Name:CECIL
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 1:306 PAIGE BND
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-5084
Mailing Address - Country:US
Mailing Address - Phone:512-293-3473
Mailing Address - Fax:512-846-2868
Practice Address - Street 1:1009 N GEORGETOWN ST
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-3289
Practice Address - Country:US
Practice Address - Phone:512-255-1720
Practice Address - Fax:512-244-8403
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107963225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics