Provider Demographics
NPI:1700173135
Name:LEHMAN, MICHELLE RENEY (COTA)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:RENEY
Last Name:LEHMAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5046 BUSH HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:CANISTEO
Mailing Address - State:NY
Mailing Address - Zip Code:14823
Mailing Address - Country:US
Mailing Address - Phone:607-698-9070
Mailing Address - Fax:
Practice Address - Street 1:9673 SILSBEE RD
Practice Address - Street 2:
Practice Address - City:HAMMONDSPORT
Practice Address - State:NY
Practice Address - Zip Code:14840-9797
Practice Address - Country:US
Practice Address - Phone:607-426-2810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007356171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY17Medicaid