Healthcare Provider Details

I. General information

NPI: 1356877567
Provider Name (Legal Business Name): MICHELLE WIRTH SHEGA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE KATHLEEN WIRTH OTR/L

II. Dates (important events)

Enumeration Date: 05/08/2017
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36711 AMERICAN WAY FLOOR 1, BUILDING BLOCKS THERAPY
AVON OH
44011
US

IV. Provider business mailing address

36711 AMERICAN WAY FLOOR 1, BUILDING BLOCKS THERAPY
AVON OH
44011
US

V. Phone/Fax

Practice location:
  • Phone: 216-282-1234
  • Fax:
Mailing address:
  • Phone: 216-282-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number056011970
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: