MEDICARE: MICHELLE NICOLE WILLOCK

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	172A00000X	Driver

General Provider Information

NPI Number	:	1336000421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE NICOLE WILLOCK

Provider Business Mailing Address
First Line	:	2201 E MAPLE ST # 2313
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-9997
Country	:	US
Telephone Number	:	330-618-3145
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 E MAPLE ST # 2313
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-9997
Country	:	US
Telephone Number	:	330-618-3145
Fax Number	:

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

Provider Enumeration Date	:	11/19/2025
Last Update Date	:	11/19/2025

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Directions to “ MICHELLE NICOLE WILLOCK ” Practice Location

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