Provider Demographics
NPI:1356877567
Name:SHEGA, MICHELLE WIRTH (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:WIRTH
Last Name:SHEGA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:KATHLEEN
Other - Last Name:WIRTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:36711 AMERICAN WAY
Mailing Address - Street 2:FLOOR 1, BUILDING BLOCKS THERAPY
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011
Mailing Address - Country:US
Mailing Address - Phone:216-282-1234
Mailing Address - Fax:
Practice Address - Street 1:36711 AMERICAN WAY
Practice Address - Street 2:FLOOR 1, BUILDING BLOCKS THERAPY
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011
Practice Address - Country:US
Practice Address - Phone:216-282-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-08
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH103K00000X
IL056011970283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst