Provider Demographics
NPI:1568138055
Name:KURAMOCHI, MICHELLE YUMI (OTR/L)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:YUMI
Last Name:KURAMOCHI
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 1:4321 E TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-9219
Mailing Address - Country:US
Mailing Address - Phone:734-999-7690
Mailing Address - Fax:
Practice Address - Street 1:2900 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2379
Practice Address - Country:US
Practice Address - Phone:269-408-4322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010608225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation