Provider Demographics
NPI:1376360685
Name:DERUE, MICHELLE C (OTD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:C
Last Name:DERUE
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HEATHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-1131
Mailing Address - Country:US
Mailing Address - Phone:585-975-9729
Mailing Address - Fax:
Practice Address - Street 1:1000 PROVIDENCE CIR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-4349
Practice Address - Country:US
Practice Address - Phone:585-865-0680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist