Provider Demographics
NPI:1326471533
Name:RAVISH, MICHELLE DENISE (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:DENISE
Last Name:RAVISH
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3812 FORRESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3036
Mailing Address - Country:US
Mailing Address - Phone:336-768-2011
Mailing Address - Fax:336-760-4258
Practice Address - Street 1:3812 FORESTGATE DRIVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3806
Practice Address - Country:US
Practice Address - Phone:336-768-2011
Practice Address - Fax:336-760-4258
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6049225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist