Provider Demographics
NPI:1619018801
Name:NEELY, MARLA (OTR, LPC)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:NEELY
Suffix:
Gender:F
Credentials:OTR, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 W AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-2340
Mailing Address - Country:US
Mailing Address - Phone:936-520-2956
Mailing Address - Fax:
Practice Address - Street 1:420 W LEWIS ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-2568
Practice Address - Country:US
Practice Address - Phone:936-520-2956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX002624225X00000X
TX69865101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist