Provider Demographics
NPI:1295872786
Name:TOR, MICHELLE C (MS OT OTR L)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:C
Last Name:TOR
Suffix:
Gender:F
Credentials:MS OT OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 STERLING AVENUE
Mailing Address - Street 2:
Mailing Address - City:N. PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772
Mailing Address - Country:US
Mailing Address - Phone:631-796-2223
Mailing Address - Fax:
Practice Address - Street 1:54 STERLING AVENUE
Practice Address - Street 2:
Practice Address - City:N. PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772
Practice Address - Country:US
Practice Address - Phone:631-796-2223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011524225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics