Provider Demographics
NPI:1407857543
Name:STELLY-SEITZ, CHARLOTTE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:MARIE
Last Name:STELLY-SEITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14707 EVERGREEN RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-2333
Mailing Address - Country:US
Mailing Address - Phone:832-721-8543
Mailing Address - Fax:
Practice Address - Street 1:14707 EVERGREEN RIDGE WAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-2333
Practice Address - Country:US
Practice Address - Phone:832-721-8543
Practice Address - Fax:832-742-0114
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG89802081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1383066908Medicaid
TX138306908OtherMEDICAID
TX138306907OtherCSHCN
TX1407857543OtherHTTPS://NPPES.CMS.HHS.GOV/NPPES
TX138306908Medicaid
TXG8980OtherMEDICAL LICENSE