Provider Demographics
NPI:1083106496
Name:IYAMU, VANESSA (OT)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:IYAMU
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17906 MISSION BLUFF LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2574
Mailing Address - Country:US
Mailing Address - Phone:713-319-7940
Mailing Address - Fax:
Practice Address - Street 1:17906 MISSION BLUFF LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-2574
Practice Address - Country:US
Practice Address - Phone:713-319-7940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116960225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics