MEDICARE: MICHELLE WESSEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT 9357	FL

General Provider Information

NPI Number	:	1063735256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE WESSEL

Provider Business Mailing Address
First Line	:	700 WATERSIDE DR
Second Line	:
City	:	HYPOLUXO
State	:	FL
Zip	:	33462-6182
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 N A ST
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-6013
Country	:	US
Telephone Number	:	561-585-9301
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2010
Last Update Date	:	02/05/2015

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