Basic Information
| Provider Information | |||||||||
| NPI: | 1609334960 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAMSUDDIN | ||||||||
| FirstName: | MUMTAZ | ||||||||
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| Credential: | OTR/L, MOT, MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2203 BABCOCK RD | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782294412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106143911 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2203 BABCOCK RD | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782294412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106143911 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2019 | ||||||||
| LastUpdateDate: | 05/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 119826 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.