Individual
TINA MICHELE MACKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3550 N SHILOH RD, RICHARDSON, TX 75082-2464
(972) 231-4810
(972) 231-4813
Mailing address
1209 SEMINARY RDG, GARLAND, TX 75043-1212
(219) 242-2308
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
213743
TX
Other
Enumeration date
08/07/2018
Last updated
08/07/2018
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