Provider Demographics
NPI:1225676687
Name:SIEGRIST, MAI KHANH (OTR)
Entity Type:Individual
Prefix:MRS
First Name:MAI
Middle Name:KHANH
Last Name:SIEGRIST
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:MAI
Other - Middle Name:KHANH
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10851 CRESCENT MOON DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-4020
Mailing Address - Country:US
Mailing Address - Phone:281-955-4100
Mailing Address - Fax:
Practice Address - Street 1:10851 CRESCENT MOON DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-4020
Practice Address - Country:US
Practice Address - Phone:281-955-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118203225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist