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General NPI Number Information
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NPI Number | 1609061696
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Entity Type | Organization
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Legal Business Name | MICHELLE L MARTIN-WIRTENSON OT, PC
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 07/15/2008
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Provider Practice Location Address
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Address Line | 231 N WISCONSIN AVE
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City | MASSAPEQUA
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State | NY
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Zip | 11758
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Country | US
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Telephone | 516-395-4271
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Fax | 516-586-3620
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Provider Business Mailing Address
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Address Line | 231 N WISCONSIN AVE
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City | MASSAPEQUA
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State | NY
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Zip | 11758
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Country | US
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Telephone | 516-395-4271
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Fax | 516-586-3620
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE WIRTENSON
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Credential | MA OTR/L
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Telephone | 516-395-4271
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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 | 007153-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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