Provider Demographics
NPI:1124509385
Name:CHISHOLM-HANKS, MACEY MARIE (COTA)
Entity type:Individual
Prefix:MS
First Name:MACEY
Middle Name:MARIE
Last Name:CHISHOLM-HANKS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 PAPOOSE TRL
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532-3218
Mailing Address - Country:US
Mailing Address - Phone:832-509-9488
Mailing Address - Fax:
Practice Address - Street 1:310 E LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TX
Practice Address - Zip Code:77535-1805
Practice Address - Country:US
Practice Address - Phone:936-258-7227
Practice Address - Fax:936-258-7223
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213522224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant