Provider Demographics
NPI:1821735390
Name:VANOORDT, MICHELE LEANN (MT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LEANN
Last Name:VANOORDT
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 S TAMERA AVE
Mailing Address - Street 2:
Mailing Address - City:MILLIKEN
Mailing Address - State:CO
Mailing Address - Zip Code:80543-8042
Mailing Address - Country:US
Mailing Address - Phone:970-213-0430
Mailing Address - Fax:
Practice Address - Street 1:195 S TAMERA AVE
Practice Address - Street 2:
Practice Address - City:MILLIKEN
Practice Address - State:CO
Practice Address - Zip Code:80543-8042
Practice Address - Country:US
Practice Address - Phone:970-213-0430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0021233225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0021233OtherD.O.R.A.