Provider Demographics
NPI:1346499092
Name:SAHOO, KAILASH CHANDRA (OT)
Entity Type:Individual
Prefix:
First Name:KAILASH
Middle Name:CHANDRA
Last Name:SAHOO
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 NATCHEZ TRACE
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013
Mailing Address - Country:US
Mailing Address - Phone:580-916-2377
Mailing Address - Fax:580-916-2377
Practice Address - Street 1:1904 NATCHEZ TRCE
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4874
Practice Address - Country:US
Practice Address - Phone:580-916-2377
Practice Address - Fax:580-916-2377
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107760225X00000X
OK779225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist