MEDICARE: MICHELLE ANN RITA YPIL-CUCUECO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	31004076A	IN

General Provider Information

NPI Number	:	1811152382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE ANN RITA YPIL-CUCUECO

Provider Business Mailing Address
First Line	:	9425 ACACIA PSGE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-9101
Country	:	US
Telephone Number	:	260-249-8563
Fax Number	:

Provider Business Practice Location Address
First Line	:	9425 ACACIA PSGE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-9101
Country	:	US
Telephone Number	:	260-249-8563
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2008
Last Update Date	:	07/24/2008

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