Healthcare Provider Details

I. General information

NPI: 1063911410
Provider Name (Legal Business Name): MISS SANDRA ESAAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 02/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5907 NINE MILE LN
MISSOURI CITY TX
77459-2590
US

IV. Provider business mailing address

1799 FM 528 RD APT 7102
WEBSTER TX
77598-4717
US

V. Phone/Fax

Practice location:
  • Phone: 469-387-4830
  • Fax:
Mailing address:
  • Phone: 469-387-4830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: