Provider Demographics
NPI:1902058712
Name:SANIL, SOUMYA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SOUMYA
Middle Name:
Last Name:SANIL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:SOUMYA
Other - Middle Name:
Other - Last Name:ZACHARIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:363 MIDSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182-3244
Mailing Address - Country:US
Mailing Address - Phone:469-563-7360
Mailing Address - Fax:
Practice Address - Street 1:363 MIDSTREAM DR
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-3244
Practice Address - Country:US
Practice Address - Phone:469-563-7360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014168-1225XP0200X
TX113414225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics