MEDICARE: SIMUEL NEZAR

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	217079	TX

General Provider Information

NPI Number	:	1932057080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIMUEL NEZAR

Provider Business Mailing Address
First Line	:	387 TETON ST
Second Line	:
City	:	WAXAHACHIE
State	:	TX
Zip	:	75165-2409
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4109 WESTRIDGE AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-7403
Country	:	US
Telephone Number	:	817-813-9431
Fax Number	:

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

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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Directions to “ SIMUEL NEZAR ” Practice Location

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