MEDICARE: INDEPENDENCE WITH THERAPY

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	86156	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0037DZ	OTHER	TX	BCBS ID

General Provider Information

NPI Number	:	1427276484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENCE WITH THERAPY

Provider Business Mailing Address
First Line	:	4602 BALCONES WOODS DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-5210
Country	:	US
Telephone Number	:	512-280-7943
Fax Number	:	512-418-1052

Provider Business Practice Location Address
First Line	:	4602 BALCONES WOODS DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-5210
Country	:	US
Telephone Number	:	512-280-7943
Fax Number	:	512-418-1052

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	MRS. LISA FIELDS
Credential	:	OT
Telephone Number	:	512-280-7943

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	08/22/2020

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Directions to “INDEPENDENCE WITH THERAPY ” Practice Location

Language	Start Address	Practice Location

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