Provider Demographics
NPI:1649418393
Name:O'CONNOR, MICHAEL PATRICK (OTR, CAPS, CBIST)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PATRICK
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:OTR, CAPS, CBIST
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 111
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-0111
Mailing Address - Country:US
Mailing Address - Phone:517-881-1302
Mailing Address - Fax:517-481-2285
Practice Address - Street 1:1106 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-5334
Practice Address - Country:US
Practice Address - Phone:517-881-1302
Practice Address - Fax:517-481-2285
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003401225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation