Provider Demographics
NPI:1922211150
Name:THE MOORE-WEIS CHILDREN'S CENTER OF AUSTIN
Entity Type:Organization
Organization Name:THE MOORE-WEIS CHILDREN'S CENTER OF AUSTIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COFOUNDER, BUSINESS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-472-6080
Mailing Address - Street 1:1303 LORRAIN ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4020
Mailing Address - Country:US
Mailing Address - Phone:512-472-6080
Mailing Address - Fax:512-472-5787
Practice Address - Street 1:1303 LORRAIN ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4020
Practice Address - Country:US
Practice Address - Phone:512-472-6080
Practice Address - Fax:512-472-5787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty