Provider Demographics
NPI:1326240912
Name:HIBBERT, MICHELLE (OTR)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:
Last Name:HIBBERT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-3411
Mailing Address - Country:US
Mailing Address - Phone:973-220-9324
Mailing Address - Fax:
Practice Address - Street 1:191 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-3411
Practice Address - Country:US
Practice Address - Phone:973-220-9324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00167400225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation