Provider Demographics
NPI:1255042511
Name:SKINNER, LINZIE MAKALA
Entity type:Individual
Prefix:
First Name:LINZIE
Middle Name:MAKALA
Last Name:SKINNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 COUNTY ROAD 4110
Mailing Address - Street 2:
Mailing Address - City:HUGHES SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75656-4515
Mailing Address - Country:US
Mailing Address - Phone:903-767-3340
Mailing Address - Fax:
Practice Address - Street 1:1018 COUNTY ROAD 4110
Practice Address - Street 2:
Practice Address - City:HUGHES SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75656-4515
Practice Address - Country:US
Practice Address - Phone:903-767-3340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX475293224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant