Provider Demographics
NPI:1962400333
Name:NIESET, MICHELE (OT)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:
Last Name:NIESET
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9368 N LILLEY RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4610
Mailing Address - Country:US
Mailing Address - Phone:734-416-3900
Mailing Address - Fax:734-416-3904
Practice Address - Street 1:49650 CHERRY HILL RD
Practice Address - Street 2:SUITE 230
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-4849
Practice Address - Country:US
Practice Address - Phone:734-495-3725
Practice Address - Fax:734-495-3734
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006521225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist