Provider Demographics
NPI:1437256823
Name:ANDERSON, MICHELLE LEE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:ANDERSON
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 1:2206 WOODED WAY
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652
Mailing Address - Country:US
Mailing Address - Phone:814-542-8630
Mailing Address - Fax:814-542-4970
Practice Address - Street 1:2109 US HWY 522 S
Practice Address - Street 2:
Practice Address - City:MCVEYTOWN
Practice Address - State:PA
Practice Address - Zip Code:17051
Practice Address - Country:US
Practice Address - Phone:814-542-8630
Practice Address - Fax:814-542-4970
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008051225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA257905OtherHEALTH AMERICA
PA50039315OtherCAPITAL BLUE CROSS