Provider Demographics
NPI:1902562705
Name:GUIDICE, MICHELLE N (OTR/L)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:N
Last Name:GUIDICE
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 1:13 BELFAST AVE
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1101
Mailing Address - Country:US
Mailing Address - Phone:908-601-3227
Mailing Address - Fax:
Practice Address - Street 1:13 BELFAST AVE
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1101
Practice Address - Country:US
Practice Address - Phone:908-601-3227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01021100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist