Provider Demographics
NPI:1407890247
Name:WOLDU, LILY FEKAD (ROT)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:FEKAD
Last Name:WOLDU
Suffix:
Gender:F
Credentials:ROT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 RED SABLE DR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2693
Mailing Address - Country:US
Mailing Address - Phone:281-292-9323
Mailing Address - Fax:281-292-9323
Practice Address - Street 1:440 BENMAR DR
Practice Address - Street 2:SUITE 1205
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-3165
Practice Address - Country:US
Practice Address - Phone:281-260-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111676225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist