Provider Demographics
NPI:1225183700
Name:TRESSA, MICHELE J
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:J
Last Name:TRESSA
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 1:55 SHOEMAKER ST
Mailing Address - Street 2:
Mailing Address - City:FORTY FORT
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4127
Mailing Address - Country:US
Mailing Address - Phone:570-829-2453
Mailing Address - Fax:570-829-2462
Practice Address - Street 1:71 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701-1312
Practice Address - Country:US
Practice Address - Phone:570-829-2453
Practice Address - Fax:570-829-2462
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC000896L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist