Healthcare Provider Details

I. General information

NPI: 1447592944
Provider Name (Legal Business Name): MRS. MIQUEL CHRISTINE CANNY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLI CANNY OTR

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 03/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16835 DEER CREEK DR SUITE 220
SPRING TX
77379-4968
US

IV. Provider business mailing address

6518 ROSE WILLOW LN
SPRING TX
77379-4995
US

V. Phone/Fax

Practice location:
  • Phone: 281-379-4373
  • Fax: 281-376-4357
Mailing address:
  • Phone: 281-381-0427
  • Fax: 281-251-9498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License Number109317
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number109317
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: