Provider Demographics
NPI:1588833255
Name:AGOMUO, NNENNA RENEE (MOT, OTR)
Entity Type:Individual
Prefix:
First Name:NNENNA
Middle Name:RENEE
Last Name:AGOMUO
Suffix:
Gender:F
Credentials:MOT, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 NORTH FWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77022-2914
Mailing Address - Country:US
Mailing Address - Phone:713-695-7455
Mailing Address - Fax:713-695-7456
Practice Address - Street 1:4625 NORTH FWY
Practice Address - Street 2:SUITE 203
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77022-2914
Practice Address - Country:US
Practice Address - Phone:713-695-7455
Practice Address - Fax:713-695-7456
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108225225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8658OTOtherBCBS
TX1852985OtherFIRST HEALTH