Provider Demographics
NPI:1245469675
Name:YENTZEN, CELIA FAYE (OTR)
Entity type:Individual
Prefix:MS
First Name:CELIA
Middle Name:FAYE
Last Name:YENTZEN
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 1:100 N TUMBLEWEED TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78733-3221
Mailing Address - Country:US
Mailing Address - Phone:512-892-7900
Mailing Address - Fax:512-280-9298
Practice Address - Street 1:4544 S LAMAR BLVD
Practice Address - Street 2:STE 750
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1500
Practice Address - Country:US
Practice Address - Phone:512-892-7900
Practice Address - Fax:512-280-9298
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109229174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109229OtherTEXAS BOARD OF OCCUPATIONAL THERAPY EXAMINERS