Provider Demographics
NPI:1619664877
Name:AYODEJI, NELSON (OTR)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:AYODEJI
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11235 MULHOLLAND DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-1230
Mailing Address - Country:US
Mailing Address - Phone:832-462-4554
Mailing Address - Fax:
Practice Address - Street 1:5600 CHENEVERT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7228
Practice Address - Country:US
Practice Address - Phone:713-521-0169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122637225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist