Provider Demographics
NPI:1033865233
Name:BUCHANAN, MICHELE MAIRE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:MAIRE
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7971 KINGSLEY DR
Mailing Address - Street 2:
Mailing Address - City:ONSTED
Mailing Address - State:MI
Mailing Address - Zip Code:49265-9408
Mailing Address - Country:US
Mailing Address - Phone:734-678-6880
Mailing Address - Fax:
Practice Address - Street 1:7971 KINGSLEY DR
Practice Address - Street 2:
Practice Address - City:ONSTED
Practice Address - State:MI
Practice Address - Zip Code:49265-9408
Practice Address - Country:US
Practice Address - Phone:734-678-6880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5727225X00000X
MI5201003762225X00000X
OR1015015225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist