Provider Demographics
NPI:1730468794
Name:SEPULVEDA, YESSICA KARINA (OTR)
Entity Type:Individual
Prefix:
First Name:YESSICA
Middle Name:KARINA
Last Name:SEPULVEDA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:YESSICA
Other - Middle Name:KARINA
Other - Last Name:OLIVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7613 URAY DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78724-3353
Mailing Address - Country:US
Mailing Address - Phone:956-246-0373
Mailing Address - Fax:
Practice Address - Street 1:2200 S LAKELINE BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4567
Practice Address - Country:US
Practice Address - Phone:512-813-9299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114167225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184911901Medicaid
TX676656Medicare UPIN