Provider Demographics
NPI:1073094926
Name:PRZYSTAC, KATHARINE MARY
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:MARY
Last Name:PRZYSTAC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 W RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-1589
Mailing Address - Country:US
Mailing Address - Phone:603-325-8851
Mailing Address - Fax:
Practice Address - Street 1:4100 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6056
Practice Address - Country:US
Practice Address - Phone:512-467-6520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119085225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist