Healthcare Provider Details

I. General information

NPI: 1811558141
Provider Name (Legal Business Name): OMEMA RAGAB ZATOUT M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3980 STATE SCHOOL RD
DENTON TX
76210-8823
US

IV. Provider business mailing address

1913 BROWN THRASHER BLVD
SAVANNAH TX
76227-7680
US

V. Phone/Fax

Practice location:
  • Phone: 940-591-3156
  • Fax:
Mailing address:
  • Phone: 469-432-0470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number103899
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: