Provider Demographics
NPI:1376776112
Name:TALLY, ERICA LEEANN (OTR)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LEEANN
Last Name:TALLY
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 1:715 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:512-260-6991
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:512-260-6991
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112966225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics