Provider Demographics
NPI:1881988558
Name:MCGHEE, MICHELE WAKELEY (COTA)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:WAKELEY
Last Name:MCGHEE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:MCGHEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:10190 BOCA ENTRADA BLVD
Mailing Address - Street 2:APT 120
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-5831
Mailing Address - Country:US
Mailing Address - Phone:561-862-7415
Mailing Address - Fax:
Practice Address - Street 1:10190 BOCA ENTRADA BLVD
Practice Address - Street 2:APT 120
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-5831
Practice Address - Country:US
Practice Address - Phone:561-862-7415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-30
Last Update Date:2011-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5525224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant