Provider Demographics
NPI:1386897023
Name:DALE SHEEN
Entity type:Organization
Organization Name:DALE SHEEN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-580-8228
Mailing Address - Street 1:1417 S LOOP W
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-3815
Mailing Address - Country:US
Mailing Address - Phone:713-790-1185
Mailing Address - Fax:
Practice Address - Street 1:1417 S LOOP W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-3815
Practice Address - Country:US
Practice Address - Phone:713-790-1185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224P00000X
TX1335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6107890001Medicare PIN