MEDICARE: MICHELLE LANGDON OTR/L

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 4377	OH

General Provider Information

NPI Number	:	1063748200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LANGDON OTR/L

Provider Business Mailing Address
First Line	:	7954 RIO GRANDE DR
Second Line	:
City	:	CLEVES
State	:	OH
Zip	:	45002-2303
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 WESTBOURNE DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45248-5127
Country	:	US
Telephone Number	:	513-451-1551
Fax Number	:	513-451-1534

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

Provider Enumeration Date	:	10/22/2009
Last Update Date	:	10/22/2009

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