Provider Demographics
NPI:1437675931
Name:KNOWLES, MICHELLE (HOME CARE PROVIDER)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:HOME CARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14204 TABOR AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-3830
Mailing Address - Country:US
Mailing Address - Phone:216-526-5663
Mailing Address - Fax:
Practice Address - Street 1:14204 TABOR AVE
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-3830
Practice Address - Country:US
Practice Address - Phone:216-526-5663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH267-899Medicaid