Provider Demographics
NPI:1457575359
Name:MCANELLY, MICHELLE (OT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MCANELLY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 WOODLAND DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2770
Mailing Address - Country:US
Mailing Address - Phone:270-763-0703
Mailing Address - Fax:270-763-0709
Practice Address - Street 1:1239 WOODLAND DR
Practice Address - Street 2:SUITE 103
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2770
Practice Address - Country:US
Practice Address - Phone:270-763-0703
Practice Address - Fax:270-763-0709
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR3209225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist