Provider Demographics
NPI:1548446180
Name:BRASHEAR, ADYANA CONSTANCE MARIE (OT)
Entity type:Individual
Prefix:
First Name:ADYANA
Middle Name:CONSTANCE MARIE
Last Name:BRASHEAR
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 1:8810 THUNDERBIRD RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78736-8006
Mailing Address - Country:US
Mailing Address - Phone:512-468-9707
Mailing Address - Fax:512-236-5183
Practice Address - Street 1:8810 THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78736-8006
Practice Address - Country:US
Practice Address - Phone:512-761-1707
Practice Address - Fax:512-236-5183
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111661225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist