MEDICARE: CARLA LYNN AUSTIN OT

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	OT6029	FL

General Provider Information

NPI Number	:	1295208122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA LYNN AUSTIN OT

Provider Business Mailing Address
First Line	:	8225 STATE ROAD 54
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-3016
Country	:	US
Telephone Number	:	813-944-9594
Fax Number	:

Provider Business Practice Location Address
First Line	:	8225 STATE ROAD 54
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-3016
Country	:	US
Telephone Number	:	813-944-9594
Fax Number	:

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

Provider Enumeration Date	:	01/03/2019
Last Update Date	:	01/03/2019

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