Provider Demographics
NPI:1063420313
Name:PAVLISKA, KERRI W (OTR)
Entity type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:W
Last Name:PAVLISKA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:KERRI
Other - Middle Name:ANN
Other - Last Name:WENTWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:3211 HANCOCK DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-5427
Mailing Address - Country:US
Mailing Address - Phone:512-533-9313
Mailing Address - Fax:512-533-9317
Practice Address - Street 1:3211 HANCOCK DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-5427
Practice Address - Country:US
Practice Address - Phone:512-533-9313
Practice Address - Fax:512-533-9317
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T1234OtherBCBS PROVIDER #
TX659627OtherBCBS PROVIDER #