Provider Demographics
NPI:1528787488
Name:OMOTAYO, TEMILOLUWA (MS CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:TEMILOLUWA
Middle Name:
Last Name:OMOTAYO
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 BISSONNET ST STE 1000W
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8001
Mailing Address - Country:US
Mailing Address - Phone:832-828-1005
Mailing Address - Fax:
Practice Address - Street 1:9700 BISSONNET ST STE 1000W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8001
Practice Address - Country:US
Practice Address - Phone:832-828-1005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120808235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist