Provider Demographics
| NPI: | 1689826075 |
|---|---|
| Name: | MIODUSZEWSKI, MICHELLE LYNN (OTR/L) |
| Entity Type: | Individual |
| Prefix: | MS |
| First Name: | MICHELLE |
| Middle Name: | LYNN |
| Last Name: | MIODUSZEWSKI |
| Suffix: | |
| Gender: | F |
| Credentials: | OTR/L |
| Other - Prefix: | |
| Other - First Name: | |
| Other - Middle Name: | |
| Other - Last Name: | |
| Other - Suffix: | |
| Other - Last Name Type: | |
| Other - Credentials: | |
| Mailing Address - Street 1: | 240 W 11TH ST STE 106 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | ERIE |
| Mailing Address - State: | PA |
| Mailing Address - Zip Code: | 16501-1758 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 814-464-0627 |
| Mailing Address - Fax: | 814-464-0629 |
| Practice Address - Street 1: | 240 W 11TH ST STE 106 |
| Practice Address - Street 2: | |
| Practice Address - City: | ERIE |
| Practice Address - State: | PA |
| Practice Address - Zip Code: | 16501-1758 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 814-464-0627 |
| Practice Address - Fax: | 814-464-0629 |
| Is Sole Proprietor?: | No |
| Enumeration Date: | 2008-10-16 |
| Last Update Date: | 2009-03-25 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| PA | OC006865L | 225X00000X, 225XE0001X, 225XE1200X, 225XF0002X, 225XG0600X, 225XL0004X, 225XN1300X, 225XP0019X, 225XP0200X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | |
| No | 225XE0001X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Environmental Modification |
| No | 225XE1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Ergonomics |
| No | 225XF0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Feeding, Eating & Swallowing |
| No | 225XG0600X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Gerontology |
| No | 225XL0004X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Low Vision |
| No | 225XN1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Neurorehabilitation |
| No | 225XP0019X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation |
| No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
