Provider Demographics
NPI:1205954807
Name:GARVIN, MICHELLE JANET
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:JANET
Last Name:GARVIN
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 1:216 E WINDSOR RD APT 2
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-2193
Mailing Address - Country:US
Mailing Address - Phone:661-259-0033
Mailing Address - Fax:
Practice Address - Street 1:21445 CENTRE POINTE PKWY
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-2684
Practice Address - Country:US
Practice Address - Phone:661-259-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner