Basic Information
| Provider Information | |||||||||
| NPI: | 1255749990 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SKELLEY | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | HIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5418 MOSSGREY LN | ||||||||
| Address2: | |||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773736995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814549462 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9953 S POST OAK RD | ||||||||
| Address2: | STE. 14 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770964309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137268558 | ||||||||
| FaxNumber: | 7137269295 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2014 | ||||||||
| LastUpdateDate: | 07/25/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 80609 | TX | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.