Healthcare Provider Details

I. General information

NPI: 1407676299
Provider Name (Legal Business Name): CHINAEDU OKWUMABUA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 POLK STREET BUILDING 14 SUITE A4
HOUSTON TX
77023
US

IV. Provider business mailing address

5301 POLK STREET BUILDING 14 SUITE A4
HOUSTON TX
77023
US

V. Phone/Fax

Practice location:
  • Phone: 832-931-2744
  • Fax:
Mailing address:
  • Phone: 832-931-2744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number209613
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: