Provider Demographics
NPI:1871626093
Name:HUET, MICHELLE M (OTR)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:M
Last Name:HUET
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 BAY FRONT DR
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-8691
Mailing Address - Country:US
Mailing Address - Phone:803-606-3719
Mailing Address - Fax:
Practice Address - Street 1:121 BAY FRONT DR
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-8691
Practice Address - Country:US
Practice Address - Phone:803-606-3719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12391225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891553900Medicaid