Provider Demographics
NPI:1336911486
Name:BAROUTJIAN, SILVIA RAQUEL (CODA)
Entity Type:Individual
Prefix:MRS
First Name:SILVIA
Middle Name:RAQUEL
Last Name:BAROUTJIAN
Suffix:
Gender:F
Credentials:CODA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11420 W. KRISTINA CIR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77316
Mailing Address - Country:US
Mailing Address - Phone:310-927-7470
Mailing Address - Fax:
Practice Address - Street 1:1999 LAKES OF WEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3252
Practice Address - Country:US
Practice Address - Phone:936-463-6439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX218125224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant