Provider Demographics
NPI:1588903843
Name:CECIL, MICHELLE R
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:R
Last Name:CECIL
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 1:653 RUDY RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-8039
Mailing Address - Country:US
Mailing Address - Phone:330-410-1453
Mailing Address - Fax:
Practice Address - Street 1:653 RUDY RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-8039
Practice Address - Country:US
Practice Address - Phone:330-410-1453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant