Provider Demographics
NPI:1205195070
Name:ACHIEVE PEDIATRIC THERAPY AND REHAB
Entity Type:Organization
Organization Name:ACHIEVE PEDIATRIC THERAPY AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TALLY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:512-260-6990
Mailing Address - Street 1:715 DISCOVERY BLVD STE 115
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2295
Mailing Address - Country:US
Mailing Address - Phone:512-260-6990
Mailing Address - Fax:
Practice Address - Street 1:715 DISCOVERY BLVD STE 115
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2295
Practice Address - Country:US
Practice Address - Phone:512-260-6990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty