Healthcare Provider Details

I. General information

NPI: 1992220677
Provider Name (Legal Business Name): TONI DAVENPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 FONDREN RD STE 102
HOUSTON TX
77096-4551
US

IV. Provider business mailing address

10101 FONDREN RD STE 102
HOUSTON TX
77096-4551
US

V. Phone/Fax

Practice location:
  • Phone: 713-774-5216
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: TONI DAVENPORT
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 713-774-5216