Healthcare Provider Details

I. General information

NPI: 1184803306
Provider Name (Legal Business Name): AMY J SANDERS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22111 RUSTIC SHORES LN
KATY TX
77450-5483
US

IV. Provider business mailing address

22111 RUSTIC SHORES LN
KATY TX
77450-5483
US

V. Phone/Fax

Practice location:
  • Phone: 281-579-7335
  • Fax:
Mailing address:
  • Phone: 281-579-7335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number112437
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: