Provider Demographics
NPI:1376326223
Name:TULLIO, MAYA (OTR/L)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:TULLIO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 BLUE RIDGE DR APT 12202
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-1586
Mailing Address - Country:US
Mailing Address - Phone:253-282-1258
Mailing Address - Fax:
Practice Address - Street 1:12 CHISHOLM TRAIL RD STE 100
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-2506
Practice Address - Country:US
Practice Address - Phone:512-341-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123846225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist