Healthcare Provider Details

I. General information

NPI: 1891108965
Provider Name (Legal Business Name): SONJA HALVORSON OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 ODYSSEY DR
WEBSTER TX
77598-1646
US

IV. Provider business mailing address

1203 CAMBRIDGE DR
FRIENDSWOOD TX
77546-5274
US

V. Phone/Fax

Practice location:
  • Phone: 281-480-5648
  • Fax:
Mailing address:
  • Phone: 832-647-0394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number103796
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: