Provider Demographics
NPI:1295379840
Name:O'QUIN, MIKEAL LYNN (MT037807)
Entity Type:Individual
Prefix:
First Name:MIKEAL
Middle Name:LYNN
Last Name:O'QUIN
Suffix:
Gender:M
Credentials:MT037807
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 E WINDING WAY DR STE 206
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-5391
Mailing Address - Country:US
Mailing Address - Phone:832-370-9713
Mailing Address - Fax:
Practice Address - Street 1:1506 E WINDING WAY DR STE 206
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5391
Practice Address - Country:US
Practice Address - Phone:832-370-9713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT037807225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty