Provider Demographics
NPI:1356531826
Name:MICELI, CHRISTINE O'BRIEN (MS, PT)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:O'BRIEN
Last Name:MICELI
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ROSELL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-1428
Mailing Address - Country:US
Mailing Address - Phone:518-877-8900
Mailing Address - Fax:
Practice Address - Street 1:2 ROSELL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BALLSTON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12019-1428
Practice Address - Country:US
Practice Address - Phone:518-877-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017257-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist