Provider Demographics
NPI:1952483844
Name:PRESLEY, MITCHEL EARL JR (LPO)
Entity Type:Individual
Prefix:MR
First Name:MITCHEL
Middle Name:EARL
Last Name:PRESLEY
Suffix:JR
Gender:M
Credentials:LPO
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Mailing Address - Street 1:140 DALLAS ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1959
Mailing Address - Country:US
Mailing Address - Phone:936-622-3850
Mailing Address - Fax:936-622-3851
Practice Address - Street 1:4800 NE STALLINGS DR
Practice Address - Street 2:SUITE 1600
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1249
Practice Address - Country:US
Practice Address - Phone:936-622-3832
Practice Address - Fax:936-622-3851
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX55225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter