Provider Demographics
NPI:1679758510
Name:MAYS, MICHELLE HOUSER (OTD, OTR, CHT)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:HOUSER
Last Name:MAYS
Suffix:
Gender:F
Credentials:OTD, OTR, CHT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:A
Other - Last Name:HOUSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:662 CHADINGS DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:IN
Mailing Address - Zip Code:46783-8875
Mailing Address - Country:US
Mailing Address - Phone:260-433-1967
Mailing Address - Fax:260-459-0282
Practice Address - Street 1:6408 CONSTITUTION DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-1558
Practice Address - Country:US
Practice Address - Phone:260-433-1967
Practice Address - Fax:260-459-0282
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004160A225XH1200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200888030Medicaid
IN11819337OtherCAQH
IN200888030Medicaid