Provider Demographics
NPI:1700929213
Name:CRACCHIOLA, MICHELE (MS, OTR)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:CRACCHIOLA
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 SW SAINT LUCIE WEST BLVD
Mailing Address - Street 2:#26
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1766
Mailing Address - Country:US
Mailing Address - Phone:772-342-8988
Mailing Address - Fax:863-467-6262
Practice Address - Street 1:906 SW SAINT LUCIE WEST BLVD
Practice Address - Street 2:#26
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1766
Practice Address - Country:US
Practice Address - Phone:772-342-8988
Practice Address - Fax:863-467-6262
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT9550225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ002JOtherBLUE CROSS BLUE SHIELD