Provider Demographics
NPI:1003256199
Name:IGBO, IKECHUKWU ANTHONY II (OTR/L, DROT)
Entity Type:Individual
Prefix:
First Name:IKECHUKWU
Middle Name:ANTHONY
Last Name:IGBO
Suffix:II
Gender:M
Credentials:OTR/L, DROT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8231 CHELSEA BEND CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-5240
Mailing Address - Country:US
Mailing Address - Phone:832-573-1102
Mailing Address - Fax:
Practice Address - Street 1:8231 CHELSEA BEND CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-5240
Practice Address - Country:US
Practice Address - Phone:832-573-1102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016890225X00000X
TX113566225X00000X
CA12397225X00000X
DC010000929225X00000X
FLOT22590225X00000X
MI5201012685225X00000X
MA13901225X00000X
MD07076174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist