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General NPI Number Information
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NPI Number | 1851754501
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Entity Type | Individual
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Provider Name | DAWN MARIE STUCKEY MED, ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 03/31/2016
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Last Update Date | 03/31/2016
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Provider Practice Location Address
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Address Line | 6100 MAIN ST # MS -548
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City | HOUSTON
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State | TX
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Zip | 77005-1827
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Country | US
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Telephone | 713-348-5410
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Fax | 713-348-5621
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Provider Business Mailing Address
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Address Line | 6100 MAIN ST # MS -548
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City | HOUSTON
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State | TX
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Zip | 77005-1827
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Country | US
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Telephone | 713-348-5410
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Fax | 713-348-5621
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | AT2698
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License Number State | TX
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