Provider Demographics
NPI:1912918236
Name:KYSER-LAFREE, MICHELE RENE (OTR)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:RENE
Last Name:KYSER-LAFREE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12158 LUPINE LN
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-7641
Mailing Address - Country:US
Mailing Address - Phone:574-935-9357
Mailing Address - Fax:
Practice Address - Street 1:2934 MILLER DR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-8083
Practice Address - Country:US
Practice Address - Phone:574-941-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000746A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist