Provider Demographics
NPI:1639302532
Name:DZULA, MICHELE JACQUELINE (OTR)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:JACQUELINE
Last Name:DZULA
Suffix:
Gender:F
Credentials:OTR
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 252
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-0252
Mailing Address - Country:US
Mailing Address - Phone:585-261-0687
Mailing Address - Fax:
Practice Address - Street 1:307 INTERNATIONAL CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21030-1321
Practice Address - Country:US
Practice Address - Phone:410-667-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2016-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003461225X00000X
NY004079-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist