Provider Demographics
NPI:1558763078
Name:LI, MINDY (MOTR/L)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 E 6TH ST
Mailing Address - Street 2:3050
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-3955
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9101 BURNET RD
Practice Address - Street 2:103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5254
Practice Address - Country:US
Practice Address - Phone:512-248-2422
Practice Address - Fax:512-248-2354
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115026225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics