Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OC006865L | PA |
N | 225XE0001X | Environmental Modification | OC006865L | PA |
N | 2251E1200X | Ergonomics | OC006865L | PA |
N | 225XE1200X | Ergonomics | OC006865L | PA |
N | 225XF0002X | Feeding, Eating & Swallowing | OC006865L | PA |
N | 225XG0600X | Occupational Therapist - Gerontology | OC006865L | PA |
N | 225XL0004X | Low Vision | OC006865L | PA |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OC006865L | PA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OC006865L | PA |
N | 225XP0200X | Occupational Therapist - Pediatrics | OC006865L | PA |
NPI | 1689826075 |
---|---|
Provider Name | Ms. Michelle Lynn Mioduszewski |
First Address | Erie, PA 16501-1758 |
Second Address | Erie, PA 16501-1758 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2008 |
Last Update Date | 25/03/2009 |