MEDICARE: MR. ALIREZA EFTEKHARI MS

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	105811	TX

General Provider Information

NPI Number	:	1326122847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALIREZA EFTEKHARI MS

Provider Business Mailing Address
First Line	:	PO BOX 550372
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75355-0372
Country	:	US
Telephone Number	:	214-348-0141
Fax Number	:

Provider Business Practice Location Address
First Line	:	2540 N GALLOWAY AVE
Second Line	:	SUITE 301-A
City	:	MESQUITE
State	:	TX
Zip	:	75150-4814
Country	:	US
Telephone Number	:	972-613-3440
Fax Number	:

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	09/09/2013

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