Provider Demographics
NPI:1477038925
Name:NGEZELONYE, EMELDA
Entity Type:Individual
Prefix:
First Name:EMELDA
Middle Name:
Last Name:NGEZELONYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2638 COTTAGE STEP TRL
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-1608
Mailing Address - Country:US
Mailing Address - Phone:469-441-2064
Mailing Address - Fax:
Practice Address - Street 1:1112 SMITH DR
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-5562
Practice Address - Country:US
Practice Address - Phone:281-331-6125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214761224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant