Provider Demographics
NPI:1134360084
Name:MICHELS, CAROL MARGARET (OTR)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:MARGARET
Last Name:MICHELS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4103 60TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-2509
Mailing Address - Country:US
Mailing Address - Phone:262-652-1111
Mailing Address - Fax:262-652-1124
Practice Address - Street 1:4103 60TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-2509
Practice Address - Country:US
Practice Address - Phone:262-652-1111
Practice Address - Fax:262-652-1124
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3536-026174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist