Basic Information
| Provider Information | |||||||||
| NPI: | 1427276484 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INDEPENDENCE WITH THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4602 BALCONES WOODS DR | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787595210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122807943 | ||||||||
| FaxNumber: | 5124181052 | ||||||||
| Practice Location | |||||||||
| Address1: | 4602 BALCONES WOODS DR | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787595210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122807943 | ||||||||
| FaxNumber: | 5124181052 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FIELDS | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OCCUPATIONAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 5122807943 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | OT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 86156 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0037DZ | 01 | TX | BCBS ID | OTHER |