Provider Demographics
NPI:1174901706
Name:WERNER, MICHELLE FAYE (MS EDS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:FAYE
Last Name:WERNER
Suffix:
Gender:F
Credentials:MS EDS, OTR/L
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:FAYE
Other - Last Name:DEITRICK-WERNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS EDS, OTR/L
Mailing Address - Street 1:3001 SE BURTON ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66605-2135
Mailing Address - Country:US
Mailing Address - Phone:785-221-9699
Mailing Address - Fax:
Practice Address - Street 1:3001 SE BURTON ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66605-2135
Practice Address - Country:US
Practice Address - Phone:785-221-9699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-00471225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS17-00471OtherKANSAS STATE BOARD OF HEALING ARTS / OCCUPATIONAL THERAPY LICENSE