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General NPI Number Information
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NPI Number | 1689270217
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Entity Type | Organization
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Legal Business Name | BRITTANY L. POLSTON MOT OTR PLLC
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Dates
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Enumeration Date | 12/09/2020
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Last Update Date | 12/09/2020
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Provider Practice Location Address
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Address Line | 12415 BLOSSOMWOOD DR
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City | AUSTIN
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State | TX
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Zip | 78727-5309
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Country | US
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Telephone | 210-379-9165
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Fax |
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Provider Business Mailing Address
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Address Line | 5900 BALCONES DR STE 100
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City | AUSTIN
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State | TX
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Zip | 78731-4298
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Country | US
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Telephone | 210-379-9165
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | BRITTANY POLSTON
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Credential | MOT OTR
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Telephone | 210-379-9165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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