Healthcare Provider Details

I. General information

NPI: 1003413592
Provider Name (Legal Business Name): RAYMOND BRYAN RUWALDT II OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 10/07/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 N POST OAK RD
HOUSTON TX
77024-3800
US

IV. Provider business mailing address

9210 N ALLEGRO ST
HOUSTON TX
77080-5520
US

V. Phone/Fax

Practice location:
  • Phone: 713-956-0870
  • Fax:
Mailing address:
  • Phone: 713-732-1670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number110011
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: