Provider Demographics
NPI:1770963456
Name:BRAUER, CARLY
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:BRAUER
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 1:9101 BURNET RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5254
Mailing Address - Country:US
Mailing Address - Phone:512-248-2422
Mailing Address - Fax:512-248-3254
Practice Address - Street 1:9101 BURNET RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5254
Practice Address - Country:US
Practice Address - Phone:512-248-2422
Practice Address - Fax:512-248-3254
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116647225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics