Provider Demographics
NPI:1689002875
Name:FORD, MICHELL ANN (LPN, LMT,)
Entity Type:Individual
Prefix:MS
First Name:MICHELL
Middle Name:ANN
Last Name:FORD
Suffix:
Gender:F
Credentials:LPN, LMT,
Other - Prefix:MS
Other - First Name:MICHELL
Other - Middle Name:ANN
Other - Last Name:SCHILLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:467 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010
Mailing Address - Country:US
Mailing Address - Phone:518-992-0074
Mailing Address - Fax:
Practice Address - Street 1:NORTHERN RIVERS
Practice Address - Street 2:122 PARK AVE
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304
Practice Address - Country:US
Practice Address - Phone:518-346-2387
Practice Address - Fax:518-579-3616
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11659174400000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist