Provider Demographics
NPI:1346871969
Name:PACE, REQUEL (MS, CTRS)
Entity Type:Individual
Prefix:MISS
First Name:REQUEL
Middle Name:
Last Name:PACE
Suffix:
Gender:F
Credentials:MS, CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4830 WILSON RD STE 300-1027
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-1971
Mailing Address - Country:US
Mailing Address - Phone:281-819-2015
Mailing Address - Fax:
Practice Address - Street 1:4830 WILSON RD STE 300-1027
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-1971
Practice Address - Country:US
Practice Address - Phone:619-415-9462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-01
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64345225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist