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General NPI Number Information
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NPI Number | 1366682114
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Entity Type | Organization
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Legal Business Name | KAMANONIE L. WILEY
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Dates
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Enumeration Date | 03/05/2009
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Last Update Date | 03/18/2009
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Provider Practice Location Address
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Address Line | 8300 BISSONETT 315
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City | HOUSTON
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State | TX
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Zip | 77074-5716
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Country | US
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Telephone | 832-892-9089
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Fax | 713-995-5356
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Provider Business Mailing Address
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Address Line | 2470 S DAIRY ASHFORD ST 137
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City | HOUSTON
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State | TX
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Zip | 77077-5716
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Country | US
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Telephone | 832-892-9089
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Fax | 713-995-5356
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MISS KAMANONIE LATISHA WILEY
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Credential | MSW
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Telephone | 504-235-9247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | 012370
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License Number State | TX
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