Healthcare Provider Details

I. General information

NPI: 1861421364
Provider Name (Legal Business Name): MICHELLE FELL OCCUPATIONAL THERAPI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE FALL

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 COUNTRY CLUB ROAD
MONONGAHELA PA
15063-2451
US

IV. Provider business mailing address

1027 COUNTRY CLUB ROAD
MONONGAHELA PA
15063-2451
US

V. Phone/Fax

Practice location:
  • Phone: 724-258-6211
  • Fax: 724-258-6225
Mailing address:
  • Phone: 724-258-6211
  • Fax: 724-258-6225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberOC003243L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC003243L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: