Provider Demographics
NPI:1659304426
Name:KING, MICHELE (OT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3439 COUNTY ROUTE 176
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-6633
Mailing Address - Country:US
Mailing Address - Phone:518-281-7874
Mailing Address - Fax:
Practice Address - Street 1:55 W 2ND ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-1515
Practice Address - Country:US
Practice Address - Phone:315-212-3676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0133558225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist