MEDICARE: FUNCTIONAL INTEGRATIVE THERAPY, PLLC

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	:	1972452225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUNCTIONAL INTEGRATIVE THERAPY, PLLC

Provider Business Mailing Address
First Line	:	13101 BARRISTER LN
Second Line	:
City	:	BUDA
State	:	TX
Zip	:	78610-4060
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13101 BARRISTER LN
Second Line	:
City	:	BUDA
State	:	TX
Zip	:	78610-4060
Country	:	US
Telephone Number	:	757-848-8853
Fax Number	:

Authorized Official
Title or Position	:	OWNER & FOUNDER
Name	:	HAYLEY SHANK
Credential	:	OTR, OTD
Telephone Number	:	757-848-8853

Provider Enumeration Date	:	01/28/2026
Last Update Date	:	06/01/2026

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