Provider Demographics
NPI:1235417692
Name:PARKER, MICHELLE DEANGEL (OTA)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:DEANGEL
Last Name:PARKER
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 154
Mailing Address - Street 2:
Mailing Address - City:HAVEN
Mailing Address - State:KS
Mailing Address - Zip Code:67543-0154
Mailing Address - Country:US
Mailing Address - Phone:620-755-5212
Mailing Address - Fax:
Practice Address - Street 1:3600 DARTMOUTH RD
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-2270
Practice Address - Country:US
Practice Address - Phone:620-663-9175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST03080224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant