Basic Information
| Provider Information | |||||||||
| NPI: | 1396116224 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MICHEL | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 NOYES ST | ||||||||
| Address2: | |||||||||
| City: | UTICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 135023854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157383977 | ||||||||
| FaxNumber: | 3157384459 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 NOYES ST | ||||||||
| Address2: | |||||||||
| City: | UTICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 135023854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157383977 | ||||||||
| FaxNumber: | 3157384459 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2015 | ||||||||
| LastUpdateDate: | 10/19/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XM0800X | 007037-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Mental Health |
No ID Information.