Provider Demographics
NPI:1477744381
Name:RONEN, MICHELLE KAY (COTA)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:KAY
Last Name:RONEN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 STONE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-8776
Mailing Address - Country:US
Mailing Address - Phone:316-284-2671
Mailing Address - Fax:316-284-2671
Practice Address - Street 1:617 STONE CREEK DR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-8776
Practice Address - Country:US
Practice Address - Phone:316-284-2671
Practice Address - Fax:316-284-2671
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-00095224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant