Provider Demographics
NPI:1851655344
Name:DUNN, MICHELLE ELANE (MT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ELANE
Last Name:DUNN
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 1:3400 MEIJER DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1166
Mailing Address - Country:US
Mailing Address - Phone:419-843-1370
Mailing Address - Fax:419-843-1362
Practice Address - Street 1:3400 MEIJER DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1166
Practice Address - Country:US
Practice Address - Phone:419-843-1370
Practice Address - Fax:419-843-1362
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33014831225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH33.014831OtherMT LICENSE