Healthcare Provider Details

I. General information

NPI: 1669225975
Provider Name (Legal Business Name): RYAN BUSCAGLIO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4407 MARATHON BLVD
AUSTIN TX
78756-3428
US

IV. Provider business mailing address

4407 MARATHON BLVD
AUSTIN TX
78756-3428
US

V. Phone/Fax

Practice location:
  • Phone: 704-500-4879
  • Fax:
Mailing address:
  • Phone: 704-500-4879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number113617
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number113617
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: