MEDICARE: JEFFREY DESPOMMIER OTR, OMS, CUA, ATP

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	225X00000X	Occupational Therapist	112891	TX
2	247200000X	Other Technician	91056

General Provider Information

NPI Number	:	1861927014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY DESPOMMIER OTR, OMS, CUA, ATP

Provider Business Mailing Address
First Line	:	9220 KIRBY DRIVE SUITE 700
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2535
Country	:	US
Telephone Number	:	832-712-8356
Fax Number	:

Provider Business Practice Location Address
First Line	:	9220 KIRBY DRIVE SUITE 700
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-1939
Country	:	US
Telephone Number	:	832-712-8356
Fax Number	:

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

Provider Enumeration Date	:	04/25/2017
Last Update Date	:	10/14/2019

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