Kathleen    Shaffer    OTR
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004618
NPI
1477501377
Tax ID
203582271
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
2415 West Pecan Street Suite 100
Pflugerville, TX 78660
United States
County
Travis
Phone
5122513230 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Occupational Therapy
Map
Address