Healthcare Provider Details

I. General information

NPI: 1235671959
Provider Name (Legal Business Name): MICHELLE KOZIEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2016
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 CARVER WOODS DR
BLUE ASH OH
45242-5529
US

IV. Provider business mailing address

4440 CARVER WOODS DR
BLUE ASH OH
45242-5529
US

V. Phone/Fax

Practice location:
  • Phone: 513-791-5688
  • Fax:
Mailing address:
  • Phone: 513-791-5688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number007024
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: