Provider Demographics
NPI:1619521648
Name:OLELEH, ISIOMA (OTR/L)
Entity Type:Individual
Prefix:
First Name:ISIOMA
Middle Name:
Last Name:OLELEH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2643 COTTAGE STEP TRL
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-1609
Mailing Address - Country:US
Mailing Address - Phone:409-655-1574
Mailing Address - Fax:
Practice Address - Street 1:1321 PARK BAYOU DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-1507
Practice Address - Country:US
Practice Address - Phone:713-320-6949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115781225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist