Provider Demographics
NPI:1699204354
Name:STINSON, MICHELLE LEA (COTA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEA
Last Name:STINSON
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 1:1187 HAYDEN HALL ROAD
Mailing Address - Street 2:
Mailing Address - City:BELLS
Mailing Address - State:TX
Mailing Address - Zip Code:75414
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1216 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-5507
Practice Address - Country:US
Practice Address - Phone:903-893-7457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210446208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation