Provider Demographics
NPI:1194723700
Name:DILLON, MICHELLE A (PT)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:A
Last Name:DILLON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:497 TUCKER DR
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-9111
Mailing Address - Country:US
Mailing Address - Phone:606-759-4678
Mailing Address - Fax:606-759-4834
Practice Address - Street 1:497 TUCKER DR
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-9111
Practice Address - Country:US
Practice Address - Phone:606-759-4678
Practice Address - Fax:606-759-4834
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT001635174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6214OtherCHA HEALTH
KY000000049626OtherANTHEM BC/BS
KY87016358Medicaid
KY87016358Medicaid