Healthcare Provider Details

I. General information

NPI: 1902936859
Provider Name (Legal Business Name): MICHELE RIFKIN WERNICK MSHED OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 YORKTOWN PLAZA CHURCH AND OLD YORK ROAD
ELKINS PARK PA
19027-3030
US

IV. Provider business mailing address

1201 STRATFORD AVE
MELROSE PARK PA
19027-3030
US

V. Phone/Fax

Practice location:
  • Phone: 215-264-6607
  • Fax:
Mailing address:
  • Phone: 215-264-6607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC000794L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: