MEDICARE: HANNAH ELIZABETH DISRAELI OTR

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	225X00000X	Occupational Therapist	305362	TX

General Provider Information

NPI Number	:	1992224505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH ELIZABETH DISRAELI OTR

Provider Business Mailing Address
First Line	:	716 INDIAN TRL STE 140
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-5702
Country	:	US
Telephone Number	:	254-213-2952
Fax Number	:	866-459-0530

Provider Business Practice Location Address
First Line	:	716 INDIAN TRL STE 140
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-5702
Country	:	US
Telephone Number	:	254-213-2952
Fax Number	:	866-459-0530

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

Provider Enumeration Date	:	09/14/2017
Last Update Date	:	07/21/2022

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