Basic Information
| Provider Information | |||||||||
| NPI: | 1154987824 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOUSTON | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | DANTE' | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 158 VANDORA HILLS PL | ||||||||
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| City: | GARNER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275295423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197715150 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3609 BOND ST | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276043801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192318113 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2019 | ||||||||
| LastUpdateDate: | 02/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 12650 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.