Provider Demographics
NPI:1316493455
Name:BADILLO, MICHELE (OTR)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:BADILLO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 W CENTRAL TEXAS EXPY
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-1890
Mailing Address - Country:US
Mailing Address - Phone:254-618-4900
Mailing Address - Fax:
Practice Address - Street 1:110 MOUNTAIN LION RD
Practice Address - Street 2:SUITE A
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-8839
Practice Address - Country:US
Practice Address - Phone:254-618-4900
Practice Address - Fax:254-618-4905
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117685225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist