Provider Demographics
NPI:1629543533
Name:QUEEN, PAUL SR
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:QUEEN
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11911 SILVER CANYON LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77067-5219
Mailing Address - Country:US
Mailing Address - Phone:832-368-8662
Mailing Address - Fax:
Practice Address - Street 1:17803 WOODBARK RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-6120
Practice Address - Country:US
Practice Address - Phone:281-370-6727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-06
Last Update Date:2018-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Multi-Specialty