MEDICARE: MICHELE SNELLGROVE

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	222Q00000X	Developmental Therapist
2	174400000X	Specialist

General Provider Information

NPI Number	:	1154442440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE SNELLGROVE

Provider Business Mailing Address
First Line	:	110 BRUSHWOOD DR
Second Line	:
City	:	FORT THOMAS
State	:	KY
Zip	:	41071-8004
Country	:	US
Telephone Number	:	859-777-4328
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 BRUSHWOOD DR
Second Line	:
City	:	FORT THOMAS
State	:	KY
Zip	:	41071-8004
Country	:	US
Telephone Number	:	859-957-7741
Fax Number	:

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	11/28/2023

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Directions to “ MICHELE SNELLGROVE ” Practice Location

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