Provider Demographics
NPI:1043784523
Name:WHITE, MICHELLE GRAY
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:GRAY
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 SCHOOLHOUSE BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-6314
Mailing Address - Country:US
Mailing Address - Phone:606-598-4082
Mailing Address - Fax:
Practice Address - Street 1:632 SCHOOLHOUSE BRANCH RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-6314
Practice Address - Country:US
Practice Address - Phone:606-598-4082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist