Provider Demographics
NPI:1285364836
Name:DELAY, MICHELE DIANE (PTA)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:DIANE
Last Name:DELAY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1854 W LAKEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:HAYSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67060-5520
Mailing Address - Country:US
Mailing Address - Phone:316-530-1475
Mailing Address - Fax:833-842-5560
Practice Address - Street 1:1854 W LAKEVIEW CT
Practice Address - Street 2:
Practice Address - City:HAYSVILLE
Practice Address - State:KS
Practice Address - Zip Code:67060-5520
Practice Address - Country:US
Practice Address - Phone:316-530-1475
Practice Address - Fax:833-842-5560
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-01194225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant