Provider Demographics
NPI:1386203651
Name:CASEBOLT, MICHELE LEE
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LEE
Last Name:CASEBOLT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30795 TWENTY THREE MILE RD.
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48043
Mailing Address - Country:US
Mailing Address - Phone:586-421-3033
Mailing Address - Fax:586-421-3031
Practice Address - Street 1:30795 TWENTY THREE MILE RD.
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48043
Practice Address - Country:US
Practice Address - Phone:586-421-3033
Practice Address - Fax:586-421-3031
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010049152251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics