Healthcare Provider Details

I. General information

NPI: 1265830137
Provider Name (Legal Business Name): MICHELLE SLATES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6057 STRIP AVE NW
NORTH CANTON OH
44720-9207
US

IV. Provider business mailing address

6057 STRIP AVE NW
NORTH CANTON OH
44720-9207
US

V. Phone/Fax

Practice location:
  • Phone: 330-309-4904
  • Fax:
Mailing address:
  • Phone: 330-309-4904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA 1063
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: