Healthcare Provider Details

I. General information

NPI: 1093598559
Provider Name (Legal Business Name): OTUM HEALTH MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5951 SOUTH LOOP
HOUSTON TX
77033-1053
US

IV. Provider business mailing address

5951 SOUTH LOOP
KATY TX
77033-1053
US

V. Phone/Fax

Practice location:
  • Phone: 917-737-2754
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: GRACE C OTUM
Title or Position: OWNER
Credential: RDN, LDN
Phone: 832-859-5830