Provider Demographics
NPI:1861421364
Name:FELL, MICHELLE (OCCUPATIONAL THERAPI)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:FELL
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:FALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1027 COUNTRY CLUB ROAD
Mailing Address - Street 2:
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063-2451
Mailing Address - Country:US
Mailing Address - Phone:724-258-6211
Mailing Address - Fax:724-258-6225
Practice Address - Street 1:1027 COUNTRY CLUB ROAD
Practice Address - Street 2:
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063-2451
Practice Address - Country:US
Practice Address - Phone:724-258-6211
Practice Address - Fax:724-258-6225
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC003243L225X00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232924881OtherTAX ID
PA0016749970001Medicaid
PA0016664300005Medicaid
PA0016664300005Medicaid