Provider Demographics
NPI:1184155178
Name:ALFORD, JERMETRICE NICOLE (CTRS, LMT)
Entity type:Individual
Prefix:MS
First Name:JERMETRICE
Middle Name:NICOLE
Last Name:ALFORD
Suffix:
Gender:F
Credentials:CTRS, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12801 ROYDON DR
Mailing Address - Street 2:APT #818
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034
Mailing Address - Country:US
Mailing Address - Phone:832-641-8660
Mailing Address - Fax:
Practice Address - Street 1:12801 ROYDON DR
Practice Address - Street 2:APT #818
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034
Practice Address - Country:US
Practice Address - Phone:832-641-8660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120766225700000X
TX54906225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist