Provider Demographics
NPI:1427105659
Name:DECANDITIS, MICHELLE P (OTRL)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:P
Last Name:DECANDITIS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
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Mailing Address - Street 1:30 SANDIA HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR CREST
Mailing Address - State:NM
Mailing Address - Zip Code:87008-9425
Mailing Address - Country:US
Mailing Address - Phone:505-286-2880
Mailing Address - Fax:505-281-3077
Practice Address - Street 1:400 CAMINO DEL BOSQUE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-2302
Practice Address - Country:US
Practice Address - Phone:505-615-7016
Practice Address - Fax:505-281-3077
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM1415225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist