Healthcare Provider Details

I. General information

NPI: 1649418393
Provider Name (Legal Business Name): MICHAEL PATRICK O'CONNOR OTR, CAPS, CBIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 N CEDAR ST
LANSING MI
48906-5334
US

IV. Provider business mailing address

PO BOX 111
MASON MI
48854-0111
US

V. Phone/Fax

Practice location:
  • Phone: 517-881-1302
  • Fax: 517-481-2285
Mailing address:
  • Phone: 517-881-1302
  • Fax: 517-481-2285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number5201003401
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: