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NPI Code Detail

MEDICARE: OCTAVIA LYNN CALLAHAN

MEDICARE: OCTAVIA LYNN CALLAHAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist
2374K00000XReligious Nonmedical Practitioner
3376J00000XHomemaker
4171400000XHealth & Wellness Coach

General Provider Information

NPI Number : 1326754953
Entity Type Code : Individual
Provider Name (Legal Business Name) : OCTAVIA LYNN CALLAHAN
Provider Business Mailing Address
First Line : 2950 S GESSNER RD STE 208
Second Line :
City : HOUSTON
State : TX
Zip : 77063-3774
Country : US
Telephone Number : 832-382-1825
Fax Number :
Provider Business Practice Location Address
First Line : 2950 S GESSNER RD STE 208
Second Line :
City : HOUSTON
State : TX
Zip : 77063-3774
Country : US
Telephone Number : 832-382-1825
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2023
Last Update Date : 01/26/2023

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Directions to “ OCTAVIA LYNN CALLAHAN ” Practice Location

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