Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | 55 | TX |
NPI | 1952483844 |
---|---|
Provider Name | Mr. Mitchel Earl Presley JR. |
First Address | Nacogdoches, TX 75965-1959 |
Second Address | Nacogdoches, TX 75965-1249 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 22/07/2007 |