Organization
LINE LEADER PEDIATRIC THERAPY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARON A WISNIESKI MS-OTR (OCCUPATIONAL THERAPIST)
(512) 619-0303
Entity
Organization
Contact information
Practice address
3303 NORTHLAND DR, SUITE 214, AUSTIN, TX 78731-4945
(512) 619-0303
(512) 291-2666
Mailing address
12928 BLOOMFIELD HILLS LN, AUSTIN, TX 78732-2066
(512) 619-0303
(512) 291-3452
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
109863
TX
225XN1300X
Neurorehabilitation Occupational Therapist
109863
TX
225XP0200X
Pediatric Occupational Therapist
Primary
109863
TX
Other
Enumeration date
08/18/2009
Last updated
02/23/2011
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