Provider Demographics
NPI:1669194247
Name:OTF WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:OTF WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-562-4926
Mailing Address - Street 1:15330 LIBERTY RIVER DR APT 6310
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77049-4084
Mailing Address - Country:US
Mailing Address - Phone:832-666-2765
Mailing Address - Fax:
Practice Address - Street 1:3303 CYPRESS CREEK PKWY STE 420
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-3612
Practice Address - Country:US
Practice Address - Phone:713-562-4926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OTF WELLNESS CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-12
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health