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General NPI Number Information
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NPI Number | 1669194247
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Entity Type | Organization
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Legal Business Name | OTF WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 09/12/2022
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 3303 CYPRESS CREEK PKWY STE 420
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City | HOUSTON
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State | TX
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Zip | 77068-3612
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Country | US
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Telephone | 713-562-4926
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Fax |
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Provider Business Mailing Address
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Address Line | 15330 LIBERTY RIVER DR APT 6310
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City | HOUSTON
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State | TX
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Zip | 77049-4084
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Country | US
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Telephone | 832-666-2765
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAWRENCE JONES
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Credential |
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Telephone | 713-562-4926
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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