| Mary Lee Foundation | |
|
1339 Lamar Square Dr Austin TX 78704 | |
| (512) 443-1360 | |
| (512) 443-1758 |
| Full Name | Mary Lee Foundation |
|---|---|
| Speciality | Clinic/Center |
| Location | 1339 Lamar Square Dr, Austin, Texas |
| Authorized Official Name and Position | Charlene Crump (DIRECTOR) |
| Authorized Official Contact | 5124435777 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Lee Foundation 1328 Lamar Square Dr. Austin TX 78704 Ph: (512) 443-1360 | Mary Lee Foundation 1339 Lamar Square Dr Austin TX 78704 Ph: (512) 443-1360 |
| NPI Number | 1083870778 |
|---|---|
| Provider Enumeration Date | 08/01/2008 |
| Last Update Date | 02/25/2020 |
| Medicare PECOS PAC ID | 9436339140 |
|---|---|
| Medicare Enrollment ID | O20200318000859 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083870778 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 261QR0400X | Clinic/center - Rehabilitation | (* (Not Available)) | Secondary |
| Provider Name | Jana Cartlidge |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1750911756 PECOS PAC ID: 3173951563 Enrollment ID: I20200318001234 |
| Provider Name | Alexandr Kostenko |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1922606805 PECOS PAC ID: 1951721380 Enrollment ID: I20201023000219 |
| Provider Name | Jacqueline Ashley Laibinis |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1669952776 PECOS PAC ID: 5698162675 Enrollment ID: I20220421000170 |
| Provider Name | Alice Lubanga |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1326125667 PECOS PAC ID: 3274513296 Enrollment ID: I20230308001134 |
| Provider Name | Jenna Elise Erben |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1598261273 PECOS PAC ID: 0042666547 Enrollment ID: I20231019000885 |
| Provider Name | Russ Dewayne Walker |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1881456648 PECOS PAC ID: 1153715446 Enrollment ID: I20240916001974 |
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