Provider Demographics
NPI:1740792860
Name:BRASWELL, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BRASWELL
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 1:1021 TURQUOISE LN
Mailing Address - Street 2:
Mailing Address - City:OAK POINT
Mailing Address - State:TX
Mailing Address - Zip Code:75068-2263
Mailing Address - Country:US
Mailing Address - Phone:512-912-6054
Mailing Address - Fax:
Practice Address - Street 1:1021 TURQUOISE LN
Practice Address - Street 2:
Practice Address - City:OAK POINT
Practice Address - State:TX
Practice Address - Zip Code:75068-2263
Practice Address - Country:US
Practice Address - Phone:512-912-6054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113491225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics