Individual
EDEM MBUKPA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2103 PURPLE MARTIN DR, BROOKSHIRE, TX 77423-2730
(347) 301-1918
Mailing address
2103 PURPLE MARTIN DR, BROOKSHIRE, TX 77423-2730
(347) 301-1918
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
215948
TX
Other
Enumeration date
08/20/2021
Last updated
08/20/2021
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