Provider Demographics
NPI:1821269416
Name:SLATER, MICHELLE CARDONE (OTR/ L)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:CARDONE
Last Name:SLATER
Suffix:
Gender:F
Credentials:OTR/ L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SOCHA LN
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-3818
Mailing Address - Country:US
Mailing Address - Phone:908-472-2697
Mailing Address - Fax:
Practice Address - Street 1:19 SOCHA LN
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12302-3818
Practice Address - Country:US
Practice Address - Phone:908-472-2697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-21
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004061225XP0200X
NJ46TR00301800225XP0200X
NY196196-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics