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General NPI Number Information
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NPI Number | 1578295390
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Entity Type | Individual
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Provider Name | MAREON LEWIS
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Gender | Male
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Dates
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Enumeration Date | 06/29/2022
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Last Update Date | 06/29/2022
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Provider Practice Location Address
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Address Line | 5406 PENZANCE CT
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City | KATY
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State | TX
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Zip | 77449-7476
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Country | US
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Telephone | 832-577-0268
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Fax |
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Provider Business Mailing Address
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Address Line | 5406 PENZANCE CT
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City | KATY
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State | TX
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Zip | 77449-7476
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Country | US
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Telephone | 832-577-0268
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XM0800X
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Taxonomy Name | Mental Health Occupational Therapist
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License Number | SMHS22225947
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License Number State | FL
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