Healthcare Provider Details

I. General information

NPI: 1912239088
Provider Name (Legal Business Name): MICHELLE L DELLINGER MS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE L HOMAN MS OTR

II. Dates (important events)

Enumeration Date: 02/01/2010
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3126 S HART STREET RD
VINCENNES IN
47591
US

IV. Provider business mailing address

3126 S HART STREET RD
VINCENNES IN
47591
US

V. Phone/Fax

Practice location:
  • Phone: 812-895-0799
  • Fax:
Mailing address:
  • Phone: 812-895-0799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31002693A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: