Provider Demographics
NPI:1760806905
Name:MAGALLON, TAMI
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:
Last Name:MAGALLON
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 1:2121 SCARSDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-5190
Mailing Address - Country:US
Mailing Address - Phone:281-464-8740
Mailing Address - Fax:
Practice Address - Street 1:2121 SCARSDALE BLVD
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-5190
Practice Address - Country:US
Practice Address - Phone:281-464-8740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101229225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist