Provider Demographics
NPI:1912462607
Name:NAIR, PRASANNA P (COTA)
Entity Type:Individual
Prefix:
First Name:PRASANNA
Middle Name:P
Last Name:NAIR
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5375 BLUE MOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-1696
Mailing Address - Country:US
Mailing Address - Phone:832-452-8925
Mailing Address - Fax:
Practice Address - Street 1:2063 MASTERS LN
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4424
Practice Address - Country:US
Practice Address - Phone:832-452-8925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208671224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty