Provider Demographics
NPI:1003357328
Name:HICKEY, MICHELLE ROSE (MS OTR/L)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ROSE
Last Name:HICKEY
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ROSE
Other - Last Name:MAURO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:221 VAN HOUTEN AVE
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-2400
Mailing Address - Country:US
Mailing Address - Phone:201-390-9896
Mailing Address - Fax:
Practice Address - Street 1:106 N FRANKLIN TPKE APT 5G
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1627
Practice Address - Country:US
Practice Address - Phone:201-327-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021331225X00000X
NJ46TR00778600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist