Provider Demographics
NPI:1073712394
Name:MCCRORY, MICHELLE DUPLECHIN (LOTR)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DUPLECHIN
Last Name:MCCRORY
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LOUISE
Other - Last Name:DUPLECHIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LOTR
Mailing Address - Street 1:725 RHINE RD SE
Mailing Address - Street 2:
Mailing Address - City:WHITE
Mailing Address - State:GA
Mailing Address - Zip Code:30184-3476
Mailing Address - Country:US
Mailing Address - Phone:504-628-5604
Mailing Address - Fax:
Practice Address - Street 1:725 RHINE RD SE
Practice Address - Street 2:
Practice Address - City:WHITE
Practice Address - State:GA
Practice Address - Zip Code:30184-3476
Practice Address - Country:US
Practice Address - Phone:604-628-5604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005338225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation