Provider Demographics
NPI:1740670231
Name:HEISER, MICHELLE QUINN (MS, ATC)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:QUINN
Last Name:HEISER
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1307
Mailing Address - Country:US
Mailing Address - Phone:321-274-2373
Mailing Address - Fax:
Practice Address - Street 1:2575 FOSTER AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1307
Practice Address - Country:US
Practice Address - Phone:321-274-2373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001915002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer