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General NPI Number Information
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NPI Number | 1912353905
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Entity Type | Organization
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Legal Business Name | OLTON SURGICAL SERVICES, LLC
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Dates
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Enumeration Date | 05/09/2016
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Last Update Date | 10/13/2020
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Provider Practice Location Address
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Address Line | 3375 WESTPARK DR UNIT 442
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City | HOUSTON
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State | TX
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Zip | 77005-4262
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Country | US
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Telephone | 832-523-3066
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Fax | 832-602-2638
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Provider Business Mailing Address
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Address Line | PO BOX 541602
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City | HOUSTON
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State | TX
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Zip | 77254-1602
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Country | US
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Telephone | 832-523-3066
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Fax | 832-602-2638
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Authorized Official
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Title or Position | LICENSED SURGICAL ASSISTANT
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Name | KATHYANN CYNTHELESE BRYANT
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Credential | LSA
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Telephone | 832-523-3066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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