Provider Demographics
NPI:1306173208
Name:DULLEA, MICHELLE J (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:J
Last Name:DULLEA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 BROOKSBY VILLAGE DR
Mailing Address - Street 2:OUTPATIENT REHABILITATION CLINIC
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-8563
Mailing Address - Country:US
Mailing Address - Phone:978-536-7980
Mailing Address - Fax:
Practice Address - Street 1:302 BROOKSBY VILLAGE DR
Practice Address - Street 2:OUTPATIENT REHABILITATION CLINIC
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-8563
Practice Address - Country:US
Practice Address - Phone:978-536-7980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8333225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist