MEDICARE: KAMANONIE L. WILEY

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	3747P1801X	Personal Care Attendant	012370	TX

General Provider Information

NPI Number	:	1366682114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAMANONIE L. WILEY

Provider Business Mailing Address
First Line	:	2470 S DAIRY ASHFORD ST
Second Line	:	137
City	:	HOUSTON
State	:	TX
Zip	:	77077-5716
Country	:	US
Telephone Number	:	832-892-9089
Fax Number	:	713-995-5356

Provider Business Practice Location Address
First Line	:	8300 BISSONETT
Second Line	:	315
City	:	HOUSTON
State	:	TX
Zip	:	77074-5716
Country	:	US
Telephone Number	:	832-892-9089
Fax Number	:	713-995-5356

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MISS KAMANONIE LATISHA WILEY
Credential	:	MSW
Telephone Number	:	504-235-9247

Provider Enumeration Date	:	03/05/2009
Last Update Date	:	03/18/2009

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