Provider Demographics
NPI:1548630494
Name:DUNN, MICHELLE (OTR/L, CHT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:DUNN
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 MOUNTAINVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL HALL
Mailing Address - State:NY
Mailing Address - Zip Code:10916-2905
Mailing Address - Country:US
Mailing Address - Phone:845-915-0115
Mailing Address - Fax:845-782-7358
Practice Address - Street 1:17 MOUNTAINVIEW DR
Practice Address - Street 2:
Practice Address - City:CAMPBELL HALL
Practice Address - State:NY
Practice Address - Zip Code:10916-2905
Practice Address - Country:US
Practice Address - Phone:845-915-0115
Practice Address - Fax:845-782-7358
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020012225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY020012OtherNEW YORK STATE OFFICE OF THE PROFESSIONS