Provider Demographics
NPI:1386951507
Name:MEDEL, MARIA MICHELLE (OTD, OTR/L)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:MICHELLE
Last Name:MEDEL
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 RISEN SON BLVD
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-1911
Mailing Address - Country:US
Mailing Address - Phone:712-366-0286
Mailing Address - Fax:712-366-0277
Practice Address - Street 1:3000 RISEN SON BLVD
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-1911
Practice Address - Country:US
Practice Address - Phone:712-366-0286
Practice Address - Fax:712-366-0277
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002037225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation