Provider Demographics
NPI:1669686689
Name:SALE, MICHA M (PT)
Entity type:Individual
Prefix:MRS
First Name:MICHA
Middle Name:M
Last Name:SALE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13313 N MERIDIAN AVE STE D3
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8316
Mailing Address - Country:US
Mailing Address - Phone:405-748-6404
Mailing Address - Fax:405-748-6322
Practice Address - Street 1:13313 N MERIDIAN AVE STE D3
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8316
Practice Address - Country:US
Practice Address - Phone:405-748-6404
Practice Address - Fax:405-748-6322
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT1540320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities