Healthcare Provider Details

I. General information

NPI: 1043033608
Provider Name (Legal Business Name): OLUWAPELUMI OSEMEN UKINAMEMEN RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 11/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8118 FRY RD STE 701
CYPRESS TX
77433-7850
US

IV. Provider business mailing address

24922 GRAND SAPPHIRE LN
KATY TX
77493-3224
US

V. Phone/Fax

Practice location:
  • Phone: 281-815-5033
  • Fax:
Mailing address:
  • Phone: 718-483-4567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-369534
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: