=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558592584
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SEEMA B QURESHI OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2009
-----------------------------------------------------
Last Update Date | 08/07/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2400 HIGHWAY 287 N STE 116
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76063-4828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-864-3572
-----------------------------------------------------
Fax | 817-887-0815
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2400 HIGHWAY 287 N STE 116
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76063-4828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-864-3572
-----------------------------------------------------
Fax | 817-887-0815
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | 111850
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------