Healthcare Provider Details

I. General information

NPI: 1124378419
Provider Name (Legal Business Name): SUSAN KESTNER CPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 ANDERSON SQ
AUSTIN TX
78757-8401
US

IV. Provider business mailing address

8000 ANDERSON SQ
AUSTIN TX
78757-8401
US

V. Phone/Fax

Practice location:
  • Phone: 512-377-2323
  • Fax: 512-374-9993
Mailing address:
  • Phone: 512-377-2323
  • Fax: 512-374-9993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number1363
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number1363
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: