Provider Demographics
NPI:1851754501
Name:STUCKEY, DAWN MARIE (MED, ATC, LAT)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:MARIE
Last Name:STUCKEY
Suffix:
Gender:F
Credentials:MED, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 MAIN ST # MS -548
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-1827
Mailing Address - Country:US
Mailing Address - Phone:713-348-5410
Mailing Address - Fax:713-348-5621
Practice Address - Street 1:6100 MAIN ST # MS -548
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-1827
Practice Address - Country:US
Practice Address - Phone:713-348-5410
Practice Address - Fax:713-348-5621
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT2698390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program