Provider Demographics
NPI:1497184881
Name:BUCHANAN, MICHELLE (COTA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BUCHANAN
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 1:302 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47620-1239
Mailing Address - Country:US
Mailing Address - Phone:812-319-1509
Mailing Address - Fax:
Practice Address - Street 1:302 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IN
Practice Address - Zip Code:47620-1239
Practice Address - Country:US
Practice Address - Phone:812-319-1509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32002384A224Z00000X
KYA5761224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant