Healthcare Provider Details

I. General information

NPI: 1508349549
Provider Name (Legal Business Name): SAJEEV GEEVARGHESE KUTTY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3406 BUSINESS CENTER DR
PEARLAND TX
77584
US

IV. Provider business mailing address

2709 WILD LILAC DR
PEARLAND TX
77584-3758
US

V. Phone/Fax

Practice location:
  • Phone: 832-323-4055
  • Fax:
Mailing address:
  • Phone: 832-323-4055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number211609
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: