Provider Demographics
NPI:1710630827
Name:OTERO, DANELIS (MT)
Entity Type:Individual
Prefix:
First Name:DANELIS
Middle Name:
Last Name:OTERO
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19414 WILDOATS DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-3954
Mailing Address - Country:US
Mailing Address - Phone:863-812-6228
Mailing Address - Fax:832-626-3627
Practice Address - Street 1:1830 SNAKE RIVER RD STE D
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-1843
Practice Address - Country:US
Practice Address - Phone:863-812-6228
Practice Address - Fax:832-626-3627
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT120918225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist