Provider Demographics
NPI:1417514498
Name:HRISEU, MICHELLE DANIELLE (CCTA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DANIELLE
Last Name:HRISEU
Suffix:
Gender:F
Credentials:CCTA
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:DANIELLE
Other - Last Name:TONTEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:THE CENTER FOR PEDIATRIC THERAPY INC
Mailing Address - Street 2:9 BRISTOL CT
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610
Mailing Address - Country:US
Mailing Address - Phone:610-670-8600
Mailing Address - Fax:610-670-9104
Practice Address - Street 1:THE CENTER FOR PEDIATRIC THERAPY INC
Practice Address - Street 2:9 BRISTOL CT
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1851
Practice Address - Country:US
Practice Address - Phone:610-670-8600
Practice Address - Fax:610-670-9104
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP009331224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant