Provider Demographics
NPI:1336786631
Name:KNOOP, MICHELLE WILCZEK (OTR/L,CHT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:WILCZEK
Last Name:KNOOP
Suffix:
Gender:F
Credentials:OTR/L,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 HEMLOCK LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-3407
Mailing Address - Country:US
Mailing Address - Phone:716-828-2455
Mailing Address - Fax:716-828-3561
Practice Address - Street 1:3669 SOUTHWESTERN BLVD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1732
Practice Address - Country:US
Practice Address - Phone:716-828-2455
Practice Address - Fax:716-828-3561
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005020225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand