Provider Demographics
NPI:1720810302
Name:KELLY-MOTHERSHED, SONYA
Entity type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:
Last Name:KELLY-MOTHERSHED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 CRAWFORD ST.
Mailing Address - Street 2:SUITE 1635
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002
Mailing Address - Country:US
Mailing Address - Phone:713-650-8888
Mailing Address - Fax:713-650-6008
Practice Address - Street 1:2000 CRAWFORD ST STE 1635
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-2370
Practice Address - Country:US
Practice Address - Phone:713-650-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services