Provider Demographics
NPI:1417422866
Name:ADEOSUN, A. (OTR/L)
Entity Type:Individual
Prefix:
First Name:A.
Middle Name:
Last Name:ADEOSUN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N SAM HOUSTON PKWY E STE 615
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-4098
Mailing Address - Country:US
Mailing Address - Phone:832-484-3756
Mailing Address - Fax:
Practice Address - Street 1:505 N SAM HOUSTON PKWY E STE 615
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-4098
Practice Address - Country:US
Practice Address - Phone:832-484-3756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119490225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist