MEDICARE: MRS. SILVIA RAQUEL BAROUTJIAN CODA

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
1	224Z00000X	Occupational Therapy Assistant	218125	TX

General Provider Information

NPI Number	:	1336911486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SILVIA RAQUEL BAROUTJIAN CODA

Provider Business Mailing Address
First Line	:	11420 W. KRISTINA CIR
Second Line	:
City	:	MONTGOMERY
State	:	TX
Zip	:	77316
Country	:	US
Telephone Number	:	310-927-7470
Fax Number	:

Provider Business Practice Location Address
First Line	:	1999 LAKES OF WEDGEWOOD DR
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-3252
Country	:	US
Telephone Number	:	936-463-6439
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2023
Last Update Date	:	10/23/2023

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