Provider Demographics
NPI:1124417779
Name:WILLE, MICHELE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:WILLE
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 1:9256 NW LAKERIDGE LN
Mailing Address - Street 2:
Mailing Address - City:POLK CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50226-2129
Mailing Address - Country:US
Mailing Address - Phone:515-371-4827
Mailing Address - Fax:
Practice Address - Street 1:701 RIVERVIEW ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2343
Practice Address - Country:US
Practice Address - Phone:515-266-1106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00444225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation