MEDICARE: MISS SANDRA ESAAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1063911410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SANDRA ESAAC

Provider Business Mailing Address
First Line	:	1799 FM 528 RD APT 7102
Second Line	:
City	:	WEBSTER
State	:	TX
Zip	:	77598-4717
Country	:	US
Telephone Number	:	469-387-4830
Fax Number	:

Provider Business Practice Location Address
First Line	:	5907 NINE MILE LN
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-2590
Country	:	US
Telephone Number	:	469-387-4830
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2018
Last Update Date	:	02/12/2018

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Directions to “ MISS SANDRA ESAAC ” Practice Location

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