Provider Demographics
NPI:1689349292
Name:BRUSENHAN, CAMILLA BRIGHT
Entity Type:Individual
Prefix:
First Name:CAMILLA
Middle Name:BRIGHT
Last Name:BRUSENHAN
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 1:2000 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-4200
Mailing Address - Country:US
Mailing Address - Phone:737-237-0016
Mailing Address - Fax:737-701-5872
Practice Address - Street 1:6818 AUSTIN CENTER BLVD STE 111
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3199
Practice Address - Country:US
Practice Address - Phone:512-418-8870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121343225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121343OtherOCCUPATIONAL THERAPY
TX1851889463OtherOCCUPATIONAL THERAPY