Basic Information
| Provider Information | |||||||||
| NPI: | 1184695447 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MICHAEL | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | O.T.R. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 61 E CHICAGO ST | ||||||||
| Address2: | |||||||||
| City: | QUINCY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490821127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5176393229 | ||||||||
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| Practice Location | |||||||||
| Address1: | 207 N TOWNLINE RD | ||||||||
| Address2: | |||||||||
| City: | LAGRANGE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 467611325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2604632143 | ||||||||
| FaxNumber: | 2604632513 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 5201003897 | MI | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 31003459A | IN | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225XH1200X | OTOO4093 | OH | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
No ID Information.