Provider Demographics
NPI:1265756019
Name:MILES-KESSELL, MICHELLE
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:MILES-KESSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:KESSELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12386 SYCAMORE RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3227
Mailing Address - Country:US
Mailing Address - Phone:858-566-8842
Mailing Address - Fax:
Practice Address - Street 1:9988 HIBERT ST STE 208
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-2480
Practice Address - Country:US
Practice Address - Phone:858-227-7229
Practice Address - Fax:858-221-4177
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2024-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7372225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand