Healthcare Provider Details

I. General information

NPI: 1558286237
Provider Name (Legal Business Name): MARIA MICHELLE AVERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6215 FERRIS SQ
SAN DIEGO CA
92121-3283
US

IV. Provider business mailing address

419 GRANDVIEW BLVD
MUSKOGEE OK
74403-8614
US

V. Phone/Fax

Practice location:
  • Phone: 800-683-1209
  • Fax:
Mailing address:
  • Phone: 918-360-4756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2058
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: