Provider Demographics
NPI:1497313324
Name:ALLEN, REGINALD ONEAL (COTA)
Entity Type:Individual
Prefix:
First Name:REGINALD
Middle Name:ONEAL
Last Name:ALLEN
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:MR
Other - First Name:REGGIE
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17103 CLAY RD APT 1404
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-4125
Mailing Address - Country:US
Mailing Address - Phone:972-900-7559
Mailing Address - Fax:
Practice Address - Street 1:17103 CLAY RD APT 1404
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-4125
Practice Address - Country:US
Practice Address - Phone:972-900-7559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215114224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX215114OtherTEXAS BOARD OF OCCUPATIONAL THERAPY EXAMINERS