Provider Demographics
NPI:1508169202
Name:HARVEY, MICHELE LEANN (COTA/L)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LEANN
Last Name:HARVEY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 405
Mailing Address - Street 2:
Mailing Address - City:GLEN FORK
Mailing Address - State:WV
Mailing Address - Zip Code:25845-0405
Mailing Address - Country:US
Mailing Address - Phone:304-237-7003
Mailing Address - Fax:
Practice Address - Street 1:1 SUTPHIN DR
Practice Address - Street 2:
Practice Address - City:MARMET
Practice Address - State:WV
Practice Address - Zip Code:25315-1977
Practice Address - Country:US
Practice Address - Phone:304-949-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-19
Last Update Date:2010-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant