Provider Demographics
NPI:1063046639
Name:MERCHANT, VICTORIA VARGAS (OT)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:VARGAS
Last Name:MERCHANT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:2851 JOE DIMAGGIO BLVD STE 12
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-3928
Mailing Address - Country:US
Mailing Address - Phone:512-244-4368
Mailing Address - Fax:
Practice Address - Street 1:2851 JOE DIMAGGIO BLVD STE 12
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-3928
Practice Address - Country:US
Practice Address - Phone:512-244-4368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-23
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104794225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist