Basic Information
| Provider Information | |||||||||
| NPI: | 1093073157 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LINTON | ||||||||
| FirstName: | STACIAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | CO, LPO | ||||||||
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| OtherLastName: | LINTON | ||||||||
| OtherFirstName: | STACEY | ||||||||
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| OtherCredential: | CO, LPO | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4601 HARTFORD ST | ||||||||
| Address2: | |||||||||
| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796054603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3257933400 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4545 HARTFORD ST | ||||||||
| Address2: | |||||||||
| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796054602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3257933400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2012 | ||||||||
| LastUpdateDate: | 02/03/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224P00000X | 1103 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Prosthetist | 222Z00000X | 1103 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Orthotist |
No ID Information.