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General NPI Number Information
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NPI Number | 1932057080
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Entity Type | Individual
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Provider Name | SIMUEL NEZAR
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Gender | Male
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Dates
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Enumeration Date | 03/16/2026
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Last Update Date | 03/16/2026
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Provider Practice Location Address
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Address Line | 4109 WESTRIDGE AVE
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City | FORT WORTH
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State | TX
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Zip | 76116-7403
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Country | US
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Telephone | 817-813-9431
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Fax |
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Provider Business Mailing Address
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Address Line | 387 TETON ST
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City | WAXAHACHIE
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State | TX
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Zip | 75165-2409
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 217079
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License Number State | TX
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