Provider Demographics
NPI:1760823298
Name:LAMB, MICHELLE (PT, AT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:LAMB
Suffix:
Gender:F
Credentials:PT, AT
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:
Other - Last Name:LAMB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, AT
Mailing Address - Street 1:13101 AIR HILL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45309-9761
Mailing Address - Country:US
Mailing Address - Phone:937-833-9350
Mailing Address - Fax:
Practice Address - Street 1:13101 AIR HILL RD
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:OH
Practice Address - Zip Code:45309-9761
Practice Address - Country:US
Practice Address - Phone:937-833-9350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 009747225100000X
OHAT 0017702255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer