Provider Demographics
NPI:1043797145
Name:ABITUA, BLAKE (COTA/L)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:
Last Name:ABITUA
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 AUSTIN PKWY APT 1806
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-1226
Mailing Address - Country:US
Mailing Address - Phone:713-303-6279
Mailing Address - Fax:
Practice Address - Street 1:2835 SHADOWBRIAR DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-3267
Practice Address - Country:US
Practice Address - Phone:281-759-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215264224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant