Basic Information
Provider Information
NPI: 1235542671
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BUDD
FirstName: ANDREA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: OT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6005 WESTVIEW DRIVE
Address2:  
City: HOUSTON
State: TX
PostalCode: 77055
CountryCode: US
TelephoneNumber: 7136962130
FaxNumber: 7136962133
Practice Location
Address1: 6005 WESTVIEW DRIVE
Address2:  
City: HOUSTON
State: TX
PostalCode: 77055
CountryCode: US
TelephoneNumber: 7136962130
FaxNumber: 7136962133
Other Information
ProviderEnumerationDate: 06/03/2014
LastUpdateDate: 06/03/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X114654TXY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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