Provider Demographics
NPI:1669724670
Name:HOULIHAN, SAMANTHA JO
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JO
Last Name:HOULIHAN
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 1:100 LC MARTIN DR
Mailing Address - Street 2:APARTMENT 502
Mailing Address - City:DEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:78016-3611
Mailing Address - Country:US
Mailing Address - Phone:210-848-6025
Mailing Address - Fax:
Practice Address - Street 1:1855 W GOODWIN ST
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:TX
Practice Address - Zip Code:78064-4502
Practice Address - Country:US
Practice Address - Phone:830-281-8202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115050225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist