Provider Demographics
NPI:1235270869
Name:MCGOWAN, MICHELLE LYNN (OT)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LYNN
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:HAINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
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:248-926-5826
Mailing Address - Fax:248-926-5830
Practice Address - Street 1:29822 S WIXOM RD
Practice Address - Street 2:
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-3434
Practice Address - Country:US
Practice Address - Phone:248-926-5826
Practice Address - Fax:248-926-5830
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201005595225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist