Provider Demographics
NPI:1457613556
Name:NETTLE, MICHELLE (MT-BC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:NETTLE
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 W SALTER DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-2350
Mailing Address - Country:US
Mailing Address - Phone:602-405-6443
Mailing Address - Fax:
Practice Address - Street 1:3025 W SALTER DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-2350
Practice Address - Country:US
Practice Address - Phone:602-405-6443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ06487OtherMUSIC THERAPY BOARD CERTIFICATION NUMBER