Provider Demographics
NPI:1679867006
Name:OFFUTT, KEELY PATRICIA (AUDIOLOGIST)
Entity type:Individual
Prefix:
First Name:KEELY
Middle Name:PATRICIA
Last Name:OFFUTT
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:KEELY
Other - Middle Name:PATRICIA
Other - Last Name:SEYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3100 SHENANDOAH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-1042
Mailing Address - Country:US
Mailing Address - Phone:713-523-3633
Mailing Address - Fax:713-523-8399
Practice Address - Street 1:3100 SHENANDOAH ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-1042
Practice Address - Country:US
Practice Address - Phone:713-523-3633
Practice Address - Fax:713-523-8399
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZE0600X
TX51499231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB132697Medicare PIN
TXTXB132695Medicare PIN
TXTXB132696Medicare PIN