MEDICARE: MACIEL 2 LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	225X00000X	Occupational Therapist
3	235Z00000X	Speech-Language Pathologist
4	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1598469637
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MACIEL 2 LLC

Provider Business Mailing Address
First Line	:	2009 S WALNUT AVE STE 103
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78130-2364
Country	:	US
Telephone Number	:	830-507-1285
Fax Number	:	512-367-5753

Provider Business Practice Location Address
First Line	:	2009 S WALNUT AVE STE 103
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78130-2364
Country	:	US
Telephone Number	:	830-507-1285
Fax Number	:	512-367-5753

Authorized Official
Title or Position	:	OWNER/CLINIC DIRECTOR
Name	:	JESSICA DOULDER
Credential	:
Telephone Number	:	512-461-3617

Provider Enumeration Date	:	03/30/2023
Last Update Date	:	01/08/2025

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Directions to “MACIEL 2 LLC ” Practice Location

Language	Start Address	Practice Location

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