Provider Demographics
NPI:1043791692
Name:DELYSER, MICHELLE (OTR/L)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:DELYSER
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 1:3525 SAND HILL RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NY
Mailing Address - Zip Code:14505-9563
Mailing Address - Country:US
Mailing Address - Phone:315-573-8275
Mailing Address - Fax:585-282-0099
Practice Address - Street 1:3525 SAND HILL RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NY
Practice Address - Zip Code:14505-9563
Practice Address - Country:US
Practice Address - Phone:315-573-8275
Practice Address - Fax:585-282-0099
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020662225X00000X
NY020662-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY020662-1OtherNBCOT