MEDICARE: CHILD THERAPY HEALING OASIS, PLLC

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
2	2251P0200X	Pediatric Physical Therapist

General Provider Information

NPI Number	:	1376789917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILD THERAPY HEALING OASIS, PLLC

Provider Business Mailing Address
First Line	:	8810 THUNDERBIRD RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78736-8006
Country	:	US
Telephone Number	:	512-761-1707
Fax Number	:	512-236-5183

Provider Business Practice Location Address
First Line	:	8810 THUNDERBIRD RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78736-8006
Country	:	US
Telephone Number	:	512-761-1707
Fax Number	:	512-236-5183

Authorized Official
Title or Position	:	OWNER & OCCUPATIONAL THERAPIST
Name	:	MS. ADYANA CONSTANCE MARIE BRASHEAR
Credential	:	OT
Telephone Number	:	512-468-9707

Provider Enumeration Date	:	01/04/2009
Last Update Date	:	07/13/2012

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