Provider Demographics
NPI:1316719578
Name:OLAREWAJU, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:OLAREWAJU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7906 COBBLER AVE NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44721-2371
Mailing Address - Country:US
Mailing Address - Phone:563-249-6513
Mailing Address - Fax:
Practice Address - Street 1:7337 CARITAS CIR NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-9126
Practice Address - Country:US
Practice Address - Phone:330-830-6130
Practice Address - Fax:330-830-6135
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT015547225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist