Healthcare Provider Details

I. General information

NPI: 1518119239
Provider Name (Legal Business Name): DEBRA LAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2008
Last Update Date: 10/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23406 KINGS FOREST RD
HOCKLEY TX
77447-9549
US

IV. Provider business mailing address

23406 KINGS FOREST RD
HOCKLEY TX
77447-9549
US

V. Phone/Fax

Practice location:
  • Phone: 281-252-3007
  • Fax:
Mailing address:
  • Phone: 281-252-3007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number209532
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: