Provider Demographics
NPI:1831757830
Name:WELLS, MICHELLE (OTR/L)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:WELLS
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 1:1080 SUTTER ST APT 403
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-5893
Mailing Address - Country:US
Mailing Address - Phone:530-906-3255
Mailing Address - Fax:
Practice Address - Street 1:1764 MARCO POLO WAY
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4503
Practice Address - Country:US
Practice Address - Phone:650-906-0870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19885225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist