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General NPI Number Information
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NPI Number | 1184802316
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Entity Type | Individual
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Provider Name | MICHELE LYNN DICRISTOFORO OTRL
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Gender | Female
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Dates
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Enumeration Date | 02/11/2008
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Last Update Date | 02/03/2014
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Provider Practice Location Address
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Address Line | 1660 STERNBLOCK LN
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City | CINCINNATI
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State | OH
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Zip | 45237-3805
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Country | US
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Telephone | 513-251-7785
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Fax |
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Provider Business Mailing Address
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Address Line | 1660 STERNBLOCK LANE SUMMIT ACADEMY
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City | CINCINNATI
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State | OH
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Zip | 45237
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Country | US
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Telephone | 513-251-7785
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT 5856
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License Number State | OH
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