MEDICARE: MRS. MARISSA YSELA FREEMAN OTR

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	109023	TX

General Provider Information

NPI Number	:	1447568399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARISSA YSELA FREEMAN OTR

Provider Business Mailing Address
First Line	:	1452 HARGIS CREEK TRL
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78717-2976
Country	:	US
Telephone Number	:	512-810-3888
Fax Number	:

Provider Business Practice Location Address
First Line	:	12151 HUNTERS CHASE DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78729-7960
Country	:	US
Telephone Number	:	512-336-4100
Fax Number	:

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

Provider Enumeration Date	:	09/14/2010
Last Update Date	:	09/14/2010

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