MEDICARE: DALE SHEEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier	1	TX
2	224P00000X	Prosthetist

General Provider Information

NPI Number	:	1386897023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALE SHEEN

Provider Business Mailing Address
First Line	:	1417 S LOOP W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-3815
Country	:	US
Telephone Number	:	713-790-1185
Fax Number	:

Provider Business Practice Location Address
First Line	:	1417 S LOOP W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-3815
Country	:	US
Telephone Number	:	713-790-1185
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KAREN M THOMSON
Credential	:
Telephone Number	:	281-580-8228

Provider Enumeration Date	:	10/28/2008
Last Update Date	:	02/18/2019

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Directions to “DALE SHEEN ” Practice Location

Language	Start Address	Practice Location

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