Provider Demographics
NPI:1013209402
Name:VAN LENNEP, MICHELLE W (OCCUPATIONAL THERAPY)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:W
Last Name:VAN LENNEP
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 OAKRIDGE ST
Mailing Address - Street 2:SUITE# 200
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-3060
Mailing Address - Country:US
Mailing Address - Phone:831-334-0086
Mailing Address - Fax:
Practice Address - Street 1:2111 S EL CAMINO REAL
Practice Address - Street 2:SUITE# 200
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-9000
Practice Address - Country:US
Practice Address - Phone:760-729-5433
Practice Address - Fax:760-729-1764
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 4073225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist