Provider Demographics
NPI:1811351661
Name:MOTT, TANIKA
Entity type:Individual
Prefix:
First Name:TANIKA
Middle Name:
Last Name:MOTT
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 1:4442 ALGERNON DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-6804
Mailing Address - Country:US
Mailing Address - Phone:281-780-1479
Mailing Address - Fax:
Practice Address - Street 1:4442 ALGERNON DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-6804
Practice Address - Country:US
Practice Address - Phone:281-780-1479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities