Healthcare Provider Details

I. General information

NPI: 1780473736
Provider Name (Legal Business Name): ASHA KUPPACHI VAS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

5500 SOUTHWESTERN MEDICAL AVE
DALLAS TX
75235-7299
US

IV. Provider business mailing address

3213 WELLS DR
PLANO TX
75093-3120
US

V. Phone/Fax

Practice location:
  • Phone: 214-718-3612
  • Fax:
Mailing address:
  • Phone: 214-718-3612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number111617
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: