MEDICARE: SAVANNAH AUSTIN

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

General Provider Information

NPI Number	:	1932507860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAVANNAH AUSTIN

Provider Business Mailing Address
First Line	:	10631 S 51ST ST #8
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044
Country	:	US
Telephone Number	:	701-471-5786
Fax Number	:

Provider Business Practice Location Address
First Line	:	10631 S 51ST ST STE 8
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-5225
Country	:	US
Telephone Number	:	480-398-4280
Fax Number	:

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

Provider Enumeration Date	:	12/09/2014
Last Update Date	:	12/09/2014

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Directions to “ SAVANNAH AUSTIN ” Practice Location

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