MEDICARE: LAYNA LEAH WHITLEY

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	205919	TX

General Provider Information

NPI Number	:	1528210291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAYNA LEAH WHITLEY

Provider Business Mailing Address
First Line	:	14911 WUNDERLICH DR APT 1406
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-2063
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14911 WUNDERLICH DR APT 1406
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-2063
Country	:	US
Telephone Number	:	281-397-0292
Fax Number	:

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

Provider Enumeration Date	:	10/14/2008
Last Update Date	:	10/14/2008

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Directions to “ LAYNA LEAH WHITLEY ” Practice Location

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