Provider Demographics
NPI:1255902367
Name:PARKER, MICHELE (OT)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 NORTHLAND CT NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-6226
Mailing Address - Country:US
Mailing Address - Phone:319-377-0937
Mailing Address - Fax:319-377-0948
Practice Address - Street 1:227 NORTHLAND CT NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-6226
Practice Address - Country:US
Practice Address - Phone:319-377-0937
Practice Address - Fax:319-377-0948
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA100960225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1232544Medicaid