Provider Demographics
NPI:1265503668
Name:TIESLING, MICHELE (OTR/L, MS)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:TIESLING
Suffix:
Gender:F
Credentials:OTR/L, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12450 CLEVELAND RD
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-8353
Mailing Address - Country:US
Mailing Address - Phone:919-772-4936
Mailing Address - Fax:919-303-3939
Practice Address - Street 1:12450 CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-8353
Practice Address - Country:US
Practice Address - Phone:919-772-4936
Practice Address - Fax:919-303-3939
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2014-09-04
Deactivation Date:2008-07-24
Deactivation Code:
Reactivation Date:2008-08-04
Provider Licenses
StateLicense IDTaxonomies
NC4950225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics