MEDICARE: COLLAB PEDIATRIC THERAPIES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103K00000X	Behavior Analyst
2	225X00000X	Occupational Therapist
3	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1871203489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLAB PEDIATRIC THERAPIES LLC

Provider Business Mailing Address
First Line	:	3111 SACBE CV
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-7520
Country	:	US
Telephone Number	:	225-937-9430
Fax Number	:

Provider Business Practice Location Address
First Line	:	3111 SACBE CV
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-7520
Country	:	US
Telephone Number	:	225-937-9430
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF SPEECH THERAPY
Name	:	LAUREN ELGIN
Credential	:	M.S., CCC-SLP
Telephone Number	:	225-937-9430

Provider Enumeration Date	:	12/05/2022
Last Update Date	:	12/05/2022

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