Provider Demographics
NPI:1407957921
Name:WIRTENSON, MICHELLE L (OTR/L)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:WIRTENSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 N WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:N MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1736
Mailing Address - Country:US
Mailing Address - Phone:516-395-4271
Mailing Address - Fax:516-420-5539
Practice Address - Street 1:231 N WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:N MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-1736
Practice Address - Country:US
Practice Address - Phone:516-395-4271
Practice Address - Fax:516-420-5539
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007153225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist