Provider Demographics
NPI:1497994677
Name:PRATT, MICHELLE LEE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LEE
Last Name:PRATT
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 1:393 TUBBS HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERKSHIRE
Mailing Address - State:NY
Mailing Address - Zip Code:13736-1521
Mailing Address - Country:US
Mailing Address - Phone:607-657-9996
Mailing Address - Fax:
Practice Address - Street 1:393 TUBBS HILL RD
Practice Address - Street 2:
Practice Address - City:BERKSHIRE
Practice Address - State:NY
Practice Address - Zip Code:13736-1521
Practice Address - Country:US
Practice Address - Phone:607-657-9996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0070851172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker