Basic Information
| Provider Information | |||||||||
| NPI: | 1801127089 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAMPTON | ||||||||
| FirstName: | ODWYER | ||||||||
| MiddleName: | FLUKER | ||||||||
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| OtherLastName: | HAMPTON | ||||||||
| OtherFirstName: | ODWYER | ||||||||
| OtherMiddleName: | FLUKER | ||||||||
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| OtherCredential: | COTA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 19519 REMINGTON PARK DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770734317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0423671205 | ||||||||
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| Practice Location | |||||||||
| Address1: | 310 E LAWRENCE ST | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775351805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9362587227 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2010 | ||||||||
| LastUpdateDate: | 02/08/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 210656 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.