Provider Demographics
NPI:1891565552
Name:FENTON, MICHELLE NICHOLE (COTA/L)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:NICHOLE
Last Name:FENTON
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 1:1 MARITHE CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-2702
Mailing Address - Country:US
Mailing Address - Phone:336-852-9700
Mailing Address - Fax:
Practice Address - Street 1:1 MARITHE CT
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-2702
Practice Address - Country:US
Practice Address - Phone:336-852-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13812224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant