Provider Demographics
NPI:1407676299
Name:OKWUMABUA, CHINAEDU
Entity type:Individual
Prefix:
First Name:CHINAEDU
Middle Name:
Last Name:OKWUMABUA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 POLK STREET BUILDING 14
Mailing Address - Street 2:SUITE A4
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77023
Mailing Address - Country:US
Mailing Address - Phone:832-931-2744
Mailing Address - Fax:
Practice Address - Street 1:5301 POLK STREET BUILDING 14
Practice Address - Street 2:SUITE A4
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77023
Practice Address - Country:US
Practice Address - Phone:832-931-2744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209613224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant