Provider Demographics
NPI:1457037137
Name:CALICUT, ANTONETTE TATUNAY
Entity Type:Individual
Prefix:
First Name:ANTONETTE
Middle Name:TATUNAY
Last Name:CALICUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17703 SEQUOIA KINGS DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-3993
Mailing Address - Country:US
Mailing Address - Phone:559-308-3805
Mailing Address - Fax:
Practice Address - Street 1:17703 SEQUOIA KINGS DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-3993
Practice Address - Country:US
Practice Address - Phone:559-308-3805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115834225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist