Provider Demographics
NPI:1508295114
Name:MCDOWELL, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MCDOWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:M
Other - Last Name:HELLEY, DUFFY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE
Mailing Address - Street 1:5445 PATRIOT DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53718-2200
Mailing Address - Country:US
Mailing Address - Phone:608-843-3457
Mailing Address - Fax:
Practice Address - Street 1:1000 CORPORATE DR
Practice Address - Street 2:SUITE 280
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334-3634
Practice Address - Country:US
Practice Address - Phone:954-636-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4917-27224Z00000X
IL057003625224Z00000X
IA000921224Z00000X
CA2407224Z00000X
TX212361224Z00000X
AZ5622224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant