Basic Information
Provider Information
NPI: 1861721078
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VU
FirstName: TERIKA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MOT, OTR
OtherOrganizationName:  
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OtherLastName:  
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Mailing Information
Address1: 1103 CYPRESS CREEK RD STE 103
Address2:  
City: CEDAR PARK
State: TX
PostalCode: 786133925
CountryCode: US
TelephoneNumber: 5129180044
FaxNumber: 5129180045
Practice Location
Address1: 1103 CYPRESS CREEK RD STE 103
Address2:  
City: CEDAR PARK
State: TX
PostalCode: 786133925
CountryCode: US
TelephoneNumber: 5129180044
FaxNumber: 5129180045
Other Information
ProviderEnumerationDate: 12/17/2009
LastUpdateDate: 12/17/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225XP0200X110635TXY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics

No ID Information.


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