MEDICARE: SUSAN HART

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	108195	TX

General Provider Information

NPI Number	:	1215353214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN HART

Provider Business Mailing Address
First Line	:	31602 CHARTER LN
Second Line	:
City	:	WALLER
State	:	TX
Zip	:	77484-7900
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 W SAM HOUSTON PKWY S
Second Line	:	SUITE 180
City	:	HOUSTON
State	:	TX
Zip	:	77042-1941
Country	:	US
Telephone Number	:	713-783-8181
Fax Number	:

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

Provider Enumeration Date	:	03/14/2014
Last Update Date	:	03/14/2014

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Directions to “ SUSAN HART ” Practice Location

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