Provider Demographics
NPI:1699441998
Name:AKANNO, YVONNE MINIMIE (COTA)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:MINIMIE
Last Name:AKANNO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:YVONNE
Other - Middle Name:MINIMIE
Other - Last Name:DERESOMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21630 MERCHANTS WAY
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-2514
Mailing Address - Country:US
Mailing Address - Phone:832-230-1518
Mailing Address - Fax:281-741-7355
Practice Address - Street 1:21630 MERCHANTS WAY
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-2514
Practice Address - Country:US
Practice Address - Phone:832-230-1518
Practice Address - Fax:281-741-7355
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216981224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant