Provider Demographics
NPI:1710602511
Name:CICCHINI, PAIGE ELIZABETH (CTRA)
Entity Type:Individual
Prefix:MS
First Name:PAIGE
Middle Name:ELIZABETH
Last Name:CICCHINI
Suffix:
Gender:F
Credentials:CTRA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5570 WHITTAKER RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9752
Mailing Address - Country:US
Mailing Address - Phone:586-504-0261
Mailing Address - Fax:
Practice Address - Street 1:5570 WHITTAKER RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-9752
Practice Address - Country:US
Practice Address - Phone:586-504-0261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI67834225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist