MEDICARE: DEMETRIA HALLEY

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	172A00000X	Driver

General Provider Information

NPI Number	:	1740668797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEMETRIA HALLEY

Provider Business Mailing Address
First Line	:	8313 SOUTHWEST FWY STE 112
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-1612
Country	:	US
Telephone Number	:	713-365-0101
Fax Number	:

Provider Business Practice Location Address
First Line	:	8313 SOUTHWEST FWY STE 112
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-1612
Country	:	US
Telephone Number	:	713-365-0101
Fax Number	:

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

Provider Enumeration Date	:	05/11/2015
Last Update Date	:	05/11/2015

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Directions to “ DEMETRIA HALLEY ” Practice Location

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