Healthcare Provider Details

I. General information

NPI: 1700458700
Provider Name (Legal Business Name): TRISHA NICOLLE OTWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2021
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 RAYFORD RD
SPRING TX
77386-4343
US

IV. Provider business mailing address

10777 KUYKENDAHL RD
THE WOODLANDS TX
77382-2772
US

V. Phone/Fax

Practice location:
  • Phone: 281-353-2420
  • Fax:
Mailing address:
  • Phone: 281-292-8026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number76104
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: