Provider Demographics
NPI:1437663168
Name:MASSEY, MICHAEL (MOT OTR)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:MASSEY
Suffix:
Gender:M
Credentials:MOT OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N JIM WRIGHT FWY
Mailing Address - Street 2:BUILDING #2
Mailing Address - City:WHITE SETTLEMENT
Mailing Address - State:TX
Mailing Address - Zip Code:76108
Mailing Address - Country:US
Mailing Address - Phone:817-900-8441
Mailing Address - Fax:817-900-8443
Practice Address - Street 1:800 N JIM WRIGHT FWY BLDG 2
Practice Address - Street 2:
Practice Address - City:WHITE SETTLEMENT
Practice Address - State:TX
Practice Address - Zip Code:76108-1068
Practice Address - Country:US
Practice Address - Phone:817-900-8441
Practice Address - Fax:817-900-8443
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110095225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist