Provider Demographics
NPI:1801127089
Name:HAMPTON, ODWYER FLUKER
Entity type:Individual
Prefix:
First Name:ODWYER
Middle Name:FLUKER
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ODWYER
Other - Middle Name:FLUKER
Other - Last Name:HAMPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:19519 REMINGTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-4317
Mailing Address - Country:US
Mailing Address - Phone:042-367-1205
Mailing Address - Fax:
Practice Address - Street 1:310 E LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TX
Practice Address - Zip Code:77535-1805
Practice Address - Country:US
Practice Address - Phone:936-258-7227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210656224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant