Healthcare Provider Details

I. General information

NPI: 1962132787
Provider Name (Legal Business Name): HAMUN SUWANNUCH OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HAMUN SUWANNUCH OTR

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 E COPELAND RD STE 300
ARLINGTON TX
76011-4910
US

IV. Provider business mailing address

7865 FIREFALL WAY APT 3510
DALLAS TX
75230-7359
US

V. Phone/Fax

Practice location:
  • Phone: 817-505-2575
  • Fax:
Mailing address:
  • Phone: 469-939-2934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number122732
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: