MEDICARE: ETOSHA PRICE

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	106S00000X	Behavior Technician
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1821664111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ETOSHA PRICE

Provider Business Mailing Address
First Line	:	11070 KATY FWY APT 1451
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043-4794
Country	:	US
Telephone Number	:	760-814-0618
Fax Number	:

Provider Business Practice Location Address
First Line	:	11070 KATY FWY APT 1451
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043-4794
Country	:	US
Telephone Number	:	760-814-0618
Fax Number	:

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

Provider Enumeration Date	:	05/28/2021
Last Update Date	:	07/18/2022

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Directions to “ ETOSHA PRICE ” Practice Location

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