Provider Demographics
NPI:1306160429
Name:EWING, MICHELLE ANN (COTA)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ANN
Last Name:EWING
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4895 PINE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-2569
Mailing Address - Country:US
Mailing Address - Phone:812-342-3098
Mailing Address - Fax:812-342-3288
Practice Address - Street 1:4895 PINE RIDGE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-2569
Practice Address - Country:US
Practice Address - Phone:812-342-3098
Practice Address - Fax:812-342-3288
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001810A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN32001810AOtherCOTA LICENSE