Provider Demographics
NPI:1053047787
Name:HOUSTON, JAMEELAH R
Entity Type:Individual
Prefix:
First Name:JAMEELAH
Middle Name:R
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4575 N MAJOR DR APT 114
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77713-8692
Mailing Address - Country:US
Mailing Address - Phone:504-258-5606
Mailing Address - Fax:
Practice Address - Street 1:4575 N MAJOR DR APT 114
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77713-8692
Practice Address - Country:US
Practice Address - Phone:504-258-5606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216727224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant