MEDICARE: AUDRIE THOMAS 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	225XP0200X	Pediatric Occupational Therapist	122384	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	122384	OTHER	TX	TEXAS DEPT OF PHYSICAL THERAPY AND OCCUPATIONAL THERAPY

General Provider Information

NPI Number	:	1164170387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDRIE THOMAS OTR

Provider Business Mailing Address
First Line	:	4613 BEE CAVES RD STE 202
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-5207
Country	:	US
Telephone Number	:	512-306-1707
Fax Number	:	512-306-7380

Provider Business Practice Location Address
First Line	:	4613 BEE CAVES RD STE 202
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-5207
Country	:	US
Telephone Number	:	512-306-1707
Fax Number	:	512-306-7380

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

Provider Enumeration Date	:	03/16/2022
Last Update Date	:	03/16/2022

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Directions to “ AUDRIE THOMAS OTR” Practice Location

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