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NPI Code Detail

MEDICARE: AMY VIRGINIA MIKELS M.S.

MEDICARE: AMY VIRGINIA MIKELS M.S.
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
1225X00000XOccupational Therapist011791-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
130-0213081OTHERNYTAX ID

General Provider Information

NPI Number : 1073607248
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY VIRGINIA MIKELS M.S.
Provider Business Mailing Address
First Line : 41 OCONNOR RD
Second Line :
City : FAIRPORT
State : NY
Zip : 14450-1327
Country : US
Telephone Number : 585-383-2216
Fax Number :
Provider Business Practice Location Address
First Line : 41 OCONNOR RD
Second Line :
City : FAIRPORT
State : NY
Zip : 14450-1327
Country : US
Telephone Number : 585-383-2216
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2006
Last Update Date : 09/25/2018

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Directions to “ AMY VIRGINIA MIKELS M.S.” Practice Location

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