Provider Demographics
NPI:1033775341
Name:DINSDALE, MICHELLE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:DINSDALE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 MANSIONS BLFS APT 712
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-4111
Mailing Address - Country:US
Mailing Address - Phone:915-355-3411
Mailing Address - Fax:
Practice Address - Street 1:9514 CONSOLE DR STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2042
Practice Address - Country:US
Practice Address - Phone:210-448-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
215273224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant