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General NPI Number Information
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NPI Number | 1700929213
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Entity Type | Individual
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Provider Name | MICHELE CRACCHIOLA MS, OTR
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Gender | Female
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 906 SW SAINT LUCIE WEST BLVD #26
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-1766
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Country | US
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Telephone | 772-342-8988
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Fax | 863-467-6262
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Provider Business Mailing Address
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Address Line | 906 SW SAINT LUCIE WEST BLVD #26
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-1766
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Country | US
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Telephone | 772-342-8988
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Fax | 863-467-6262
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT9550
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License Number State | FL
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