Provider Demographics
NPI:1770890709
Name:CORDRAY, MICHELLE A (MOT, OTR/L, CLT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:CORDRAY
Suffix:
Gender:F
Credentials:MOT, OTR/L, CLT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:A
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2219 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-4212
Mailing Address - Country:US
Mailing Address - Phone:303-990-4597
Mailing Address - Fax:
Practice Address - Street 1:207 S BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-5905
Practice Address - Country:US
Practice Address - Phone:402-462-8824
Practice Address - Fax:402-462-8017
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1433225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist