Provider Demographics
NPI:1851559637
Name:DEWOLFF, OREN DAVID (LMT)
Entity Type:Individual
Prefix:
First Name:OREN
Middle Name:DAVID
Last Name:DEWOLFF
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 AUGUSTA DR STE 183
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-4989
Mailing Address - Country:US
Mailing Address - Phone:713-409-0655
Mailing Address - Fax:
Practice Address - Street 1:2400 AUGUSTA DR STE 183
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-4989
Practice Address - Country:US
Practice Address - Phone:713-409-0655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT106222225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist