Provider Demographics
NPI:1427397736
Name:AMATO, MICHELLE ALICE (OTR/L)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ALICE
Last Name:AMATO
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 1:3311 FRIENDSHIP ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-1619
Mailing Address - Country:US
Mailing Address - Phone:607-727-4949
Mailing Address - Fax:
Practice Address - Street 1:2500 NESHAMINY INTERPLEX DR
Practice Address - Street 2:
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6943
Practice Address - Country:US
Practice Address - Phone:267-991-7633
Practice Address - Fax:267-991-7618
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011970251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization