Provider Demographics
NPI:1821414129
Name:BASILE, MICHELE ANNE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:ANNE
Last Name:BASILE
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 1:2486 BRYTON DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7409
Mailing Address - Country:US
Mailing Address - Phone:614-888-8910
Mailing Address - Fax:
Practice Address - Street 1:2486 BRYTON DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7409
Practice Address - Country:US
Practice Address - Phone:614-888-8910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT 002674174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist