Provider Demographics
NPI:1902936859
Name:RIFKIN WERNICK, MICHELE (MSHED OTRL)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:RIFKIN WERNICK
Suffix:
Gender:F
Credentials:MSHED OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 STRATFORD AVE
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-3030
Mailing Address - Country:US
Mailing Address - Phone:215-264-6607
Mailing Address - Fax:
Practice Address - Street 1:325 YORKTOWN PLAZA
Practice Address - Street 2:CHURCH AND OLD YORK ROAD
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-3030
Practice Address - Country:US
Practice Address - Phone:215-264-6607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC000794L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA098823U36Medicare UPIN