Provider Demographics
NPI:1821305236
Name:FOREMAN, MICHELLE D (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:D
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 JOLINE LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10307-1913
Mailing Address - Country:US
Mailing Address - Phone:718-984-7900
Mailing Address - Fax:718-984-4290
Practice Address - Street 1:10 JOLINE LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10307-1913
Practice Address - Country:US
Practice Address - Phone:718-984-7900
Practice Address - Fax:718-984-4290
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006107-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant