Provider Demographics
NPI:1457488801
Name:RADETSKY, LINDA DIANE (OT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:DIANE
Last Name:RADETSKY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9718B SUGAR HILL DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-5834
Mailing Address - Country:US
Mailing Address - Phone:512-699-0472
Mailing Address - Fax:
Practice Address - Street 1:9718B SUGAR HILL DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-5834
Practice Address - Country:US
Practice Address - Phone:512-699-0472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104081225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00936XMedicare ID - Type UnspecifiedPART B GROUP NUMBER
TX676626Medicare Oscar/Certification
TX676554Medicare Oscar/Certification
TX676564Medicare Oscar/Certification
TX676600Medicare Oscar/Certification
TX676555Medicare Oscar/Certification
TX676559Medicare Oscar/Certification