Provider Demographics
NPI:1306074158
Name:OKOLI, MARY U
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:U
Last Name:OKOLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8815 RIVERWELL CIR E
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-7722
Mailing Address - Country:US
Mailing Address - Phone:713-825-4968
Mailing Address - Fax:281-879-1485
Practice Address - Street 1:8815 RIVERWELL CIR E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-7722
Practice Address - Country:US
Practice Address - Phone:713-825-4968
Practice Address - Fax:281-879-1485
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010703172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker