Provider Demographics
NPI:1487963419
Name:FURUSETH, MICHELLE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:FURUSETH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:LATTERELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:172 SUMMIT AVE W
Mailing Address - Street 2:
Mailing Address - City:BLACKDUCK
Mailing Address - State:MN
Mailing Address - Zip Code:56630-2140
Mailing Address - Country:US
Mailing Address - Phone:281-835-3425
Mailing Address - Fax:
Practice Address - Street 1:172 SUMMIT AVE W
Practice Address - Street 2:
Practice Address - City:BLACKDUCK
Practice Address - State:MN
Practice Address - Zip Code:56630-2140
Practice Address - Country:US
Practice Address - Phone:281-835-3425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102946225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist