Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT-04157 | OH |
Y | 2251P0200X | Physical Therapist - Pediatrics | PT-04157 | OH |
NPI | 1134321060 |
---|---|
Provider Name | Michelle B. Wetzel |
First Address | Canton, OH 44718-1078 |
Second Address | North Canton, OH 44720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2007 |
Last Update Date | 31/07/2018 |