Healthcare Provider Details

I. General information

NPI: 1518354976
Provider Name (Legal Business Name): SAMIRA SALEH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 05/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 CASTELLA COVE
LEANDER TX
78641-3152
US

IV. Provider business mailing address

17751 PARK VALLEY DR
ROUND ROCK TX
78681-3592
US

V. Phone/Fax

Practice location:
  • Phone: 512-773-4335
  • Fax:
Mailing address:
  • Phone: 512-218-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number114930
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: