MEDICARE: ASSISTIVE TECHNOLOGY SERVICES OF TEXAS

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	235Z00000X	Speech-Language Pathologist	104189	TX

General Provider Information

NPI Number	:	1801197355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSISTIVE TECHNOLOGY SERVICES OF TEXAS

Provider Business Mailing Address
First Line	:	3014 W WILLIAM CANNON DR
Second Line	:	1521
City	:	AUSTIN
State	:	TX
Zip	:	78745-5135
Country	:	US
Telephone Number	:	512-293-0307
Fax Number	:

Provider Business Practice Location Address
First Line	:	3014 W WILLIAM CANNON DR
Second Line	:	1521
City	:	AUSTIN
State	:	TX
Zip	:	78745-5135
Country	:	US
Telephone Number	:	512-293-0307
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	MR. CAMERON BARKER WILLIAMS
Credential	:	CCC-SLP
Telephone Number	:	512-293-0307

Provider Enumeration Date	:	11/14/2010
Last Update Date	:	11/14/2010

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