Provider Demographics
NPI:1427283431
Name:LISA P. OTEY
Entity type:Organization
Organization Name:LISA P. OTEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINASTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-790-9265
Mailing Address - Street 1:7900 FANNIN ST STE 3200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2942
Mailing Address - Country:US
Mailing Address - Phone:713-790-9265
Mailing Address - Fax:713-790-1006
Practice Address - Street 1:7900 FANNIN ST STE 3200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2942
Practice Address - Country:US
Practice Address - Phone:713-790-9265
Practice Address - Fax:713-790-1006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1342174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A0096Medicare PIN