Provider Demographics
NPI:1396221826
Name:WARNER, MICHELLE YVONNE (OT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:YVONNE
Last Name:WARNER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:YVONNE
Other - Last Name:CHRISTIANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16820 E HELMAUR PL
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-7555
Mailing Address - Country:US
Mailing Address - Phone:907-982-4298
Mailing Address - Fax:
Practice Address - Street 1:984 N MERIDIAN PL # A
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7215
Practice Address - Country:US
Practice Address - Phone:907-631-4029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK135121225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist