Provider Demographics
NPI:1265006084
Name:ADIX, MICHAEL ARTHUR (OTR)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ARTHUR
Last Name:ADIX
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6714 STATE HWY 57
Mailing Address - Street 2:
Mailing Address - City:BAILEYS HARBOR
Mailing Address - State:WI
Mailing Address - Zip Code:54202
Mailing Address - Country:US
Mailing Address - Phone:315-842-2841
Mailing Address - Fax:
Practice Address - Street 1:855 MANKATO AVE
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-4868
Practice Address - Country:US
Practice Address - Phone:507-454-3650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist