Individual
JEANIE R SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
111350
TX
225XP0200X
Pediatric Occupational Therapist
Primary
111350
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710691-01
—
TX
Enumeration date
01/29/2007
Last updated
09/25/2025
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