Provider Demographics
NPI:1417283698
Name:AYALA, KAREN B (OTR/CHT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:B
Last Name:AYALA
Suffix:
Gender:F
Credentials:OTR/CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 S LAKELINE BLVD, SUITE 100
Mailing Address - Street 2:TILLMAN PHYSICAL THERAPY & SPORTS TRAINING CENTER, INC
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2964
Mailing Address - Country:US
Mailing Address - Phone:512-331-6200
Mailing Address - Fax:512-331-4312
Practice Address - Street 1:2519 S LAKELINE BLVD, SUITE 100
Practice Address - Street 2:TILLMAN PHYSICAL THERAPY & SPORTS TRAINING CENTER, INC
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2964
Practice Address - Country:US
Practice Address - Phone:512-331-6200
Practice Address - Fax:512-331-4312
Is Sole Proprietor?:No
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113187225X00000X
TX1011100582225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT 1397OtherOCCUPATIONAL THERAPY LICENSE
TX1011100582OtherCERTIFIED HAND THERAPIST
TX113187OtherTEXAS LICENSE-OTR