Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OC009170 | PA |
N | 225XH1200X | Occupational Therapist - Hand | OC009170 | PA |
NPI | 1053506766 |
---|---|
Provider Name | Michele Lynn Bailey-Fenush |
First Address | State College, PA 16801-7965 |
Second Address | State College, PA 16801-7965 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2007 |
Last Update Date | 18/10/2016 |