Basic Information
| Provider Information | |||||||||
| NPI: | 1851468003 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LENT | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | M | ||||||||
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| OtherLastName: | LENT | ||||||||
| OtherFirstName: | MICHELLE | ||||||||
| OtherMiddleName: | METZGER | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 412 MAPLE AVE | ||||||||
| Address2: | |||||||||
| City: | BELLWOOD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166172038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147428871 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 208 LAKEMONT PARK BOULEVARD | ||||||||
| Address2: | HNA EARLY INTERVENTION | ||||||||
| City: | ALTOONA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8149448177 | ||||||||
| FaxNumber: | 8149447413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0016806530006 | 05 | PA | MEDICAID | 40007 | 01 | PA | HIGHMARK | OTHER |