Provider Demographics
NPI:1972811784
Name:KMITCH, MICHELE
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:
Last Name:KMITCH
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 1:6835 JEWETT HOLMWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-3021
Mailing Address - Country:US
Mailing Address - Phone:171-667-3031
Mailing Address - Fax:
Practice Address - Street 1:2495 MAIN ST
Practice Address - Street 2:SUITE 234
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2152
Practice Address - Country:US
Practice Address - Phone:716-836-5929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0034321224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant