Healthcare Provider Details

I. General information

NPI: 1033797410
Provider Name (Legal Business Name): HANAN JALAL KHALIL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E MEDICAL CENTER BLVD
WEBSTER TX
77598-4301
US

IV. Provider business mailing address

4925 FORT CROCKETT BLVD APT 621
GALVESTON TX
77551-5950
US

V. Phone/Fax

Practice location:
  • Phone: 832-224-9500
  • Fax:
Mailing address:
  • Phone: 361-676-4020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number443949
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number443949
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: