Healthcare Provider Details

I. General information

NPI: 1982912341
Provider Name (Legal Business Name): MICHELLE LYNN BARBULEAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ELMWOOD AVE
ROCHESTER NY
14620-3042
US

IV. Provider business mailing address

1465 WATERFORD RD
WALWORTH NY
14568-9590
US

V. Phone/Fax

Practice location:
  • Phone: 585-271-0761
  • Fax:
Mailing address:
  • Phone: 585-721-7455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number011156-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: