Provider Demographics
NPI:1447763644
Name:SOWELL, DEIDRA MARIE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:DEIDRA
Middle Name:MARIE
Last Name:SOWELL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26345 3RD TER
Mailing Address - Street 2:
Mailing Address - City:SPLENDORA
Mailing Address - State:TX
Mailing Address - Zip Code:77372-5017
Mailing Address - Country:US
Mailing Address - Phone:832-527-4666
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:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213537224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant