MEDICARE: MICHELLE REPP

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	103K00000X	Behavior Analyst	7401003144	MI

General Provider Information

NPI Number	:	1083577928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE REPP

Provider Business Mailing Address
First Line	:	18501 ROTUNDA DR
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-3891
Country	:	US
Telephone Number	:	313-996-1960
Fax Number	:

Provider Business Practice Location Address
First Line	:	18501 ROTUNDA DR
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-3891
Country	:	US
Telephone Number	:	313-996-1960
Fax Number	:

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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Directions to “ MICHELLE REPP ” Practice Location

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