Provider Demographics
NPI:1962157040
Name:TREVINO, MICHELLE (OTR)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:TREVINO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:DE LOS SANTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3900 MALLOW CT
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7219
Mailing Address - Country:US
Mailing Address - Phone:972-322-3111
Mailing Address - Fax:
Practice Address - Street 1:6401 OHIO DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-6700
Practice Address - Country:US
Practice Address - Phone:972-618-8963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108162225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist