Provider Demographics
NPI:1720577471
Name:VAJIRASARN, EMILY ROSE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ROSE
Last Name:VAJIRASARN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 N WASHINGTON AVE STE 4000
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1776
Mailing Address - Country:US
Mailing Address - Phone:214-820-7457
Mailing Address - Fax:214-820-1654
Practice Address - Street 1:411 N WASHINGTON AVE STE 4000
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1776
Practice Address - Country:US
Practice Address - Phone:214-820-7457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118962225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist