Healthcare Provider Details

I. General information

NPI: 1053388843
Provider Name (Legal Business Name): MICHELE MERWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 LAKE SHORE DR W
DUNKIRK NY
14048-1437
US

IV. Provider business mailing address

186 LAKE SHORE DR W
DUNKIRK NY
14048-1437
US

V. Phone/Fax

Practice location:
  • Phone: 716-366-6125
  • Fax:
Mailing address:
  • Phone: 716-366-6125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number005766
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: