Provider Demographics
NPI:1487024451
Name:ROSS, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 BROOKLYN AVE
Mailing Address - Street 2:3RD FLR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-3427
Mailing Address - Country:US
Mailing Address - Phone:347-982-6765
Mailing Address - Fax:
Practice Address - Street 1:1606 BROOKLYN AVE
Practice Address - Street 2:3RD FLR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-3427
Practice Address - Country:US
Practice Address - Phone:347-982-6765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0065611224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant