MEDICARE: IRIS SAMIR GEIRGEIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	215461	TX

General Provider Information

NPI Number	:	1528802113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRIS SAMIR GEIRGEIS

Provider Business Mailing Address
First Line	:	4841 BRIDLE PATH WAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-7911
Country	:	US
Telephone Number	:	646-387-2339
Fax Number	:

Provider Business Practice Location Address
First Line	:	4841 BRIDLE PATH WAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-7911
Country	:	US
Telephone Number	:	646-387-2339
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2024
Last Update Date	:	06/19/2024

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Directions to “ IRIS SAMIR GEIRGEIS ” Practice Location

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