Healthcare Provider Details

I. General information

NPI: 1245658152
Provider Name (Legal Business Name): SEYI JENNIFER OTERI DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2014
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 MAIN ST STE 204
RICHMOND TX
77469-3230
US

IV. Provider business mailing address

1601 MAIN ST STE 204
RICHMOND TX
77469-3230
US

V. Phone/Fax

Practice location:
  • Phone: 832-449-3520
  • Fax: 855-398-4568
Mailing address:
  • Phone: 832-449-3520
  • Fax: 855-398-4568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2250
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2250
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: