Provider Demographics
NPI:1326754953
Name:CALLAHAN, OCTAVIA LYNN
Entity Type:Individual
Prefix:
First Name:OCTAVIA
Middle Name:LYNN
Last Name:CALLAHAN
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 1:2950 S GESSNER RD STE 208
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-3774
Mailing Address - Country:US
Mailing Address - Phone:832-382-1825
Mailing Address - Fax:
Practice Address - Street 1:2950 S GESSNER RD STE 208
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-3774
Practice Address - Country:US
Practice Address - Phone:832-382-1825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No174400000XOther Service ProvidersSpecialist
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No376J00000XNursing Service Related ProvidersHomemaker