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NPI Code Detail

MEDICARE: JORDAN BREANN FAZIO

MEDICARE: JORDAN BREANN FAZIO
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
1225X00000XOccupational Therapist125605TX

General Provider Information

NPI Number : 1861330599
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN BREANN FAZIO
Provider Business Mailing Address
First Line : 8340 BLUFF SPRINGS RD UNIT 11008
Second Line :
City : AUSTIN
State : TX
Zip : 78744-1342
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8340 BLUFF SPRINGS RD UNIT 11008
Second Line :
City : AUSTIN
State : TX
Zip : 78744-1342
Country : US
Telephone Number : 210-219-8366
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2026
Last Update Date : 03/23/2026

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Directions to “ JORDAN BREANN FAZIO ” Practice Location

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