Healthcare Provider Details

I. General information

NPI: 1295872786
Provider Name (Legal Business Name): MICHELLE C TOR MS OT OTR L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 STERLING AVENUE
N. PATCHOGUE NY
11772
US

IV. Provider business mailing address

54 STERLING AVENUE
N. PATCHOGUE NY
11772
US

V. Phone/Fax

Practice location:
  • Phone: 631-796-2223
  • Fax:
Mailing address:
  • Phone: 631-796-2223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number011524
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: