Provider Demographics
NPI:1255723730
Name:HOUSTON, JAMES (OTR)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:HOUSTON
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 1:102 MANDI DR
Mailing Address - Street 2:
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-8739
Mailing Address - Country:US
Mailing Address - Phone:662-680-3148
Mailing Address - Fax:877-276-4918
Practice Address - Street 1:2844 TRACELAND DR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4200
Practice Address - Country:US
Practice Address - Phone:662-680-3148
Practice Address - Fax:877-276-4918
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT0624314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility