Provider Demographics
NPI:1053647644
Name:CELESTINE, ORA MAE
Entity type:Individual
Prefix:
First Name:ORA
Middle Name:MAE
Last Name:CELESTINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ORA
Other - Middle Name:MAE
Other - Last Name:WHITMIRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MT
Mailing Address - Street 1:3130 CRESTDALE DR APT 1071
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080-3935
Mailing Address - Country:US
Mailing Address - Phone:832-790-9907
Mailing Address - Fax:
Practice Address - Street 1:3130 CRESTDALE DR APT 1071
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-3935
Practice Address - Country:US
Practice Address - Phone:832-790-9907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT107121225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist