MEDICARE: KATIE NICOLE RUSNAK OTR

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	225X00000X	Occupational Therapist	110126	TX

General Provider Information

NPI Number	:	1013106145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE NICOLE RUSNAK OTR

Provider Business Mailing Address
First Line	:	1201 W 38TH ST
Second Line	:	SETON 8TH FLOOR NORTH
City	:	AUSTIN
State	:	TX
Zip	:	78705-1006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9001 BRODIE LN STE C8
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-5005
Country	:	US
Telephone Number	:	512-712-4192
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2007
Last Update Date	:	03/08/2024

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