MEDICARE: THE EXPRESSIVE COLLECTIVE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	224Z00000X	Occupational Therapy Assistant
2	225100000X	Physical Therapist
3	225X00000X	Occupational Therapist
4	2355S0801X	Speech-Language Assistant
5	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1396504320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE EXPRESSIVE COLLECTIVE, LLC

Provider Business Mailing Address
First Line	:	102 SALINAS CV
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78738-1781
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1823 FORTVIEW RD STE 104
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-7663
Country	:	US
Telephone Number	:	512-377-1065
Fax Number	:

Authorized Official
Title or Position	:	CO-FOUNDER
Name	:	CARLY NEWHOUSE
Credential	:
Telephone Number	:	914-380-2356

Provider Enumeration Date	:	03/13/2024
Last Update Date	:	03/13/2024

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Directions to “THE EXPRESSIVE COLLECTIVE, LLC ” Practice Location

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