Provider Demographics
NPI:1740533249
Name:SCHWARZ, MICHELLE LYNN
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:SCHWARZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CYBULSKI RD
Mailing Address - Street 2:APT A
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3229
Mailing Address - Country:US
Mailing Address - Phone:860-305-0965
Mailing Address - Fax:
Practice Address - Street 1:8 CYBULSKI RD
Practice Address - Street 2:APT A
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3229
Practice Address - Country:US
Practice Address - Phone:860-305-0965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006402225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist