Provider Demographics
NPI:1669787404
Name:BOMBATA, HAKEEM KUNLE (COTA)
Entity type:Individual
Prefix:MR
First Name:HAKEEM
Middle Name:KUNLE
Last Name:BOMBATA
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:8514 BROMPTON PLACE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-5287
Mailing Address - Country:US
Mailing Address - Phone:281-491-0051
Mailing Address - Fax:281-491-0051
Practice Address - Street 1:8514 BROMPTON PLACE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-5287
Practice Address - Country:US
Practice Address - Phone:281-491-0051
Practice Address - Fax:281-491-0051
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204647224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant