Provider Demographics
NPI:1730590969
Name:DISNEY, ANNE MICHELLE (OTR/L)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MICHELLE
Last Name:DISNEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2378 WOODLAKE DR
Mailing Address - Street 2:#280
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-6013
Mailing Address - Country:US
Mailing Address - Phone:517-706-0421
Mailing Address - Fax:
Practice Address - Street 1:2378 WOODLAKE DR
Practice Address - Street 2:#280
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-6013
Practice Address - Country:US
Practice Address - Phone:517-706-0421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-09
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056010552174400000X
MI5201009342225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No174400000XOther Service ProvidersSpecialist