Provider Demographics
NPI:1407179138
Name:WOODY, JENNIFER BUIE (OTR)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BUIE
Last Name:WOODY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17203 S BRISTLE PINE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-6354
Mailing Address - Country:US
Mailing Address - Phone:713-306-7505
Mailing Address - Fax:
Practice Address - Street 1:13300 HARGRAVE RD STE 49
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4373
Practice Address - Country:US
Practice Address - Phone:281-664-1990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109649225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist