Provider Demographics
NPI:1043096910
Name:GIPSON, SHAMIA (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:SHAMIA
Middle Name:
Last Name:GIPSON
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12447 HUNTINGTON VENTURE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-4508
Mailing Address - Country:US
Mailing Address - Phone:713-885-1415
Mailing Address - Fax:
Practice Address - Street 1:5819 HIGHWAY 6 STE 115
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4061
Practice Address - Country:US
Practice Address - Phone:281-403-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123946225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist