Provider Demographics
NPI:1689356024
Name:WAZIRALI, DIYA
Entity Type:Individual
Prefix:
First Name:DIYA
Middle Name:
Last Name:WAZIRALI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23225 KINGSLAND BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-3705
Mailing Address - Country:US
Mailing Address - Phone:281-395-9090
Mailing Address - Fax:281-395-9091
Practice Address - Street 1:5401 LA CROSSE AVE STE 101
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78739-2160
Practice Address - Country:US
Practice Address - Phone:512-852-8134
Practice Address - Fax:512-852-8143
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123216225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist