Provider Demographics
NPI:1972069490
Name:HOPKINS, MICHELLE ALECE
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ALECE
Last Name:HOPKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2532 DETOUR ROAD
Mailing Address - Street 2:
Mailing Address - City:GREAT CACAPON
Mailing Address - State:WV
Mailing Address - Zip Code:25422
Mailing Address - Country:US
Mailing Address - Phone:304-258-7723
Mailing Address - Fax:
Practice Address - Street 1:400 CLOCKTOWER RIDGE DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22603-3878
Practice Address - Country:US
Practice Address - Phone:540-431-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131002139224Z00000X
WVC2255224Z00000X
MDA02732224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant