Healthcare Provider Details

I. General information

NPI: 1659016095
Provider Name (Legal Business Name): LISA KUCHLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA BERRES

II. Dates (important events)

Enumeration Date: 04/30/2022
Last Update Date: 04/30/2022
Certification Date: 04/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MEDICAL PKWY
LAKEWAY TX
78738-5627
US

IV. Provider business mailing address

7817 LYNCHBURG DR
AUSTIN TX
78738-7649
US

V. Phone/Fax

Practice location:
  • Phone: 970-460-0538
  • Fax:
Mailing address:
  • Phone: 970-460-0538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number119618
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: