Healthcare Provider Details

I. General information

NPI: 1841771185
Provider Name (Legal Business Name): SUZANNE HRABOVSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 S IH 35 E
WAXAHACHIE TX
75165-5427
US

IV. Provider business mailing address

6232 ENSIGN RD
ENNIS TX
75119-1303
US

V. Phone/Fax

Practice location:
  • Phone: 972-935-0090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number211906
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: