Basic Information
| Provider Information | |||||||||
| NPI: | 1437783347 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCMICHAEL | ||||||||
| FirstName: | JOAN | ||||||||
| MiddleName: | ONGAT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 836 NIGHTINGALE CT NE | ||||||||
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| City: | KEIZER | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973033408 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4062 ARLETA AVE NE | ||||||||
| Address2: | |||||||||
| City: | KEIZER | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973034758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033902271 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/29/2020 | ||||||||
| LastUpdateDate: | 02/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 235486 | OR | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.