Provider Demographics
NPI:1164220034
Name:DIMALANTA, TIMOTHY EBBA
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:EBBA
Last Name:DIMALANTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6715 GREENWOOD VALLEY PL
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-7972
Mailing Address - Country:US
Mailing Address - Phone:832-816-8205
Mailing Address - Fax:832-816-8205
Practice Address - Street 1:19255 PARK ROW
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-7309
Practice Address - Country:US
Practice Address - Phone:832-404-2649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX218717224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant