Provider Demographics
NPI:1871998690
Name:MICHELLE PUCKETT OT LLC
Entity type:Organization
Organization Name:MICHELLE PUCKETT OT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:DROT, OTR/L
Authorized Official - Phone:205-447-9969
Mailing Address - Street 1:246 CHADWICK LANE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:AL
Mailing Address - Zip Code:35080
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:246 CHADWICK LANE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AL
Practice Address - Zip Code:35080
Practice Address - Country:US
Practice Address - Phone:205-447-9969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2508251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health