Provider Demographics
NPI:1992320782
Name:NEALEY, MICHELLE MORGAN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MORGAN
Last Name:NEALEY
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 1:18065 COASTLINE DR APT 4
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-5714
Mailing Address - Country:US
Mailing Address - Phone:424-346-2426
Mailing Address - Fax:
Practice Address - Street 1:18065 COASTLINE DR APT 4
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-5714
Practice Address - Country:US
Practice Address - Phone:424-346-2426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13935225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty