Provider Demographics
NPI:1275935157
Name:VAIL, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:VAIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 BROOKTONDALE RD
Mailing Address - Street 2:APT D
Mailing Address - City:BROOKTONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:14817-9565
Mailing Address - Country:US
Mailing Address - Phone:315-406-6149
Mailing Address - Fax:
Practice Address - Street 1:217 BROOKTONDALE RD
Practice Address - Street 2:APT D
Practice Address - City:BROOKTONDALE
Practice Address - State:NY
Practice Address - Zip Code:14817-9565
Practice Address - Country:US
Practice Address - Phone:315-406-6149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP94821225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist