MEDICARE: MARY AZELE REEVES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	110835	TX

General Provider Information

NPI Number	:	1033322235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY AZELE REEVES

Provider Business Mailing Address
First Line	:	14928 CORDERO DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78717-4533
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 W 34TH ST
Second Line	:	SUITE 250
City	:	AUSTIN
State	:	TX
Zip	:	78705-1143
Country	:	US
Telephone Number	:	512-454-4599
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	07/08/2007

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