Healthcare Provider Details

I. General information

NPI: 1477052322
Provider Name (Legal Business Name): MICHELLE TOR INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 02/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 STERLING AVE
PATCHOGUE NY
11772-1553
US

IV. Provider business mailing address

54 STERLING AVE
PATCHOGUE NY
11772-1553
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225CA2400X
TaxonomyAssistive Technology Practitioner Rehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number011524-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MICHELLE TOR
Title or Position: OT/OWNER
Credential: OTR/L
Phone: 631-796-2223