Provider Demographics
NPI:1326568445
Name:ISGUR, YONDER LAUREL (OT)
Entity Type:Individual
Prefix:
First Name:YONDER
Middle Name:LAUREL
Last Name:ISGUR
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12881 SUNSHINE RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:TX
Mailing Address - Zip Code:76534-5080
Mailing Address - Country:US
Mailing Address - Phone:512-992-8074
Mailing Address - Fax:
Practice Address - Street 1:1424 MARTIN LUTHER KING JR LN
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-5941
Practice Address - Country:US
Practice Address - Phone:254-791-8280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110263225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist