Provider Demographics
NPI:1992207559
Name:TREVILLIAN, MICHELLE SUE (OTRL)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SUE
Last Name:TREVILLIAN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15166 RING RD
Mailing Address - Street 2:
Mailing Address - City:BRANT
Mailing Address - State:MI
Mailing Address - Zip Code:48614-9791
Mailing Address - Country:US
Mailing Address - Phone:989-239-9133
Mailing Address - Fax:
Practice Address - Street 1:3340 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-9622
Practice Address - Country:US
Practice Address - Phone:989-790-7812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201001838225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist