Provider Demographics
NPI:1982029682
Name:NOCK, MICHELLE RENEE'
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:RENEE'
Last Name:NOCK
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 1:1006 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:POCOMOKE CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21851-1206
Mailing Address - Country:US
Mailing Address - Phone:410-957-2252
Mailing Address - Fax:410-957-4603
Practice Address - Street 1:1006 MARKET ST
Practice Address - Street 2:
Practice Address - City:POCOMOKE CITY
Practice Address - State:MD
Practice Address - Zip Code:21851-1206
Practice Address - Country:US
Practice Address - Phone:410-957-2252
Practice Address - Fax:410-957-4603
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-04
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA02110224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant