MEDICARE: MRS. MICHELLE COIL O.T.

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	31002996A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000378651	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1598858151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE COIL O.T.

Provider Business Mailing Address
First Line	:	3574 N 850 W
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-9341
Country	:	US
Telephone Number	:	219-210-3709
Fax Number	:

Provider Business Practice Location Address
First Line	:	8259 WICKER AVE
Second Line	:
City	:	SAINT JOHN
State	:	IN
Zip	:	46373-8878
Country	:	US
Telephone Number	:	800-870-4540
Fax Number	:	219-365-6561

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	09/27/2010

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