Provider Demographics
NPI:1447592944
Name:CANNY, MIQUEL CHRISTINE
Entity Type:Individual
Prefix:MRS
First Name:MIQUEL
Middle Name:CHRISTINE
Last Name:CANNY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KELLI
Other - Middle Name:
Other - Last Name:CANNY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:6518 ROSE WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-4995
Mailing Address - Country:US
Mailing Address - Phone:281-381-0427
Mailing Address - Fax:281-251-9498
Practice Address - Street 1:16835 DEER CREEK DR
Practice Address - Street 2:SUITE 220
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-4968
Practice Address - Country:US
Practice Address - Phone:281-379-4373
Practice Address - Fax:281-376-4357
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109317225XE0001X, 225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental Modification
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109317Medicare UPIN