Healthcare Provider Details

I. General information

NPI: 1740174713
Provider Name (Legal Business Name): QUAZI TALHA HOSSAIN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 COTTONWOOD CREEK TRL # TX78613
CEDAR PARK TX
78613-7555
US

IV. Provider business mailing address

1913 RACHEL LN
ROUND ROCK TX
78664-7454
US

V. Phone/Fax

Practice location:
  • Phone: 512-259-4259
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: