Healthcare Provider Details

I. General information

NPI: 1306172549
Provider Name (Legal Business Name): MARIA SUSANA GUMPEL OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2009
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CHELSEA BLVD
HOUSTON TX
77006-6202
US

IV. Provider business mailing address

1216 HOWARD LN
BELLAIRE TX
77401-2706
US

V. Phone/Fax

Practice location:
  • Phone: 713-807-1131
  • Fax: 713-807-1141
Mailing address:
  • Phone: 713-664-6109
  • Fax: 713-807-1141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number106284
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: