Provider Demographics
NPI:1497235410
Name:ANTUNEZ, KIM RAYDON (OTA)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:RAYDON
Last Name:ANTUNEZ
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32410 WATERHOUSE CT
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-4077
Mailing Address - Country:US
Mailing Address - Phone:713-907-4342
Mailing Address - Fax:
Practice Address - Street 1:3434 WATTERS RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-2015
Practice Address - Country:US
Practice Address - Phone:713-941-9155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207562224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty