1417101718 NPI number — MS. COURTNEE RAE GABEL OTR/CHT

Table of content: MS. COURTNEE RAE GABEL OTR/CHT (NPI 1417101718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417101718 NPI number — MS. COURTNEE RAE GABEL OTR/CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GABEL
Provider First Name:
COURTNEE
Provider Middle Name:
RAE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/CHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417101718
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4333 DARSEY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLAIRE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77401-5604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-687-8660
Provider Business Mailing Address Fax Number:
713-523-2452

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2158 PORTSMOUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77098-4057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-529-4990
Provider Business Practice Location Address Fax Number:
713-523-2452
Provider Enumeration Date:
11/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XH1200X , with the licence number:  103121 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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