Provider Demographics
NPI:1386782134
Name:OBBINK, MICHELLE BETH (OTR,CHT)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:BETH
Last Name:OBBINK
Suffix:
Gender:F
Credentials:OTR,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 LAKE CT
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53013-1670
Mailing Address - Country:US
Mailing Address - Phone:920-668-8854
Mailing Address - Fax:
Practice Address - Street 1:151 LAKE CT
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:WI
Practice Address - Zip Code:53013-1670
Practice Address - Country:US
Practice Address - Phone:920-668-8854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1653-026225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP90106Medicare UPIN