Provider Demographics
NPI:1912170770
Name:MAHMOUD, DERAR (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:DERAR
Middle Name:
Last Name:MAHMOUD
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17911 HYDE COVE CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-5010
Mailing Address - Country:US
Mailing Address - Phone:713-384-0525
Mailing Address - Fax:
Practice Address - Street 1:12777 BEECHNUT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-3820
Practice Address - Country:US
Practice Address - Phone:281-879-8040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113970225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113970OtherTEXAS OCCUPATIONAL THERAPY LICENSE